EFEKTIVITAS SALEP JINTAN HITAM (Nigella Sativa) PADA PROSES PENYEMBUHAN LUKA PERINEUM RUPTURE IBU NIFAS

Latar Belakang : Penyebab kematian maternal di Indonesia terkait persalinan adalah infeksi 11% berawal dari penatalaksanaan ruptur perineum yang kurang baik. Sekitar 85% wanita yang melahirkan spontan pervaginam mengalami trauma perineum, sebanyak 1% mengalami infeksi. Ruptur perineum perlu mendapatkan perhatian karena dapat menyebabkan disfungsi organ reproduksi wanita menyebabkan kematian karena perdarahan atau sepsis. Prosedur perawatan luka perineum saat ini masih menggunakan cairan desinfektan Povidon Iodin 10%, belum ada yang berbentuk obat herbal salep sebagai tambahan perlindungan luka dan mengurangi ketidaknyamanan luka perineum. Sehingga penulis tertarik untuk melakukan penelitian efektivitas Salep Jintan Hitam 5 % dan 10 % dalam penyembuhan luka perineum rupture ibu nifas di RSUD Puruk Cahu, Kabupaten Murung Raya, Kalimantan Tengah. Metode : 21 ibu nifas dengan luka Perineum rupture derajat II, dibagi menjadi 3 kelompok secara random menggunakan Rancangan penelitian Randomised pre-post test control group design. Salep jintan hitam 5% dan 10% dioleskan pada luka Perineum rupture setiap hari, selama 7 hari postpartum sesuai kelompok perlakuan. Penilaian luka menggunakan skala REEDA dilakukan pada hari 1 (pre test), hari 3, 5 dan 7 (post test). Hasil : Salep jintan hitam efektif mempercepat proses penyembuhan luka Perineum rupture pada ibu nifas sejak hari ke-3 dilihat dari penurunan nilai Redness, Oedema, Ecchymosis secara signifikan dibanding kelompok kontrol (p0,05), tetapi secara deskriptif Salep jintan hitam 10% lebih efektif dalam proses penyembuhan luka Perineum rupture pada ibu nifas dibandingkan Salep jintan hitam 5%. Kesimpulan : Salep jintan hitam berperan pada fase inflamasi dengan menghambat pembentukkan kinin dan prostglandin secara tidak langsung, sedangkan pada fase proliferasi Salep jintan hitam berperan dalam angiogenesis, sintesis kolagen, dan kontraksi luka. Salep jintan hitam 10% lebih efektif dibandingkan Salep jintan hitam 5%. Kata kunci : Salep jintan hitam 5% dan 10%, Redness, Oedema, Ecchymosis Discharge, Aprroximation, Luka. Background: The main cause of maternal mortality in Indonesia in the bearing process is infection. Eleven per cent of the infection come from bad treatment of perineum rupturee. There are about 85% women bearing through spontaneuous pervaginam experience perineum trauma and 1% of them are infected. Perineum rupture needs serious attention since it can cause woman reproduction organ disfunction and dead as the consequence of bleeding or sepsis. The procedure of perineum treatment still uses desinfectant lotion Povidon Iodin 10%, herbal oinment as additional wound protector and perineum pain killer. Because of this, the researcher is interested in studying the effectiveness of nigella sativa 5% and 10% in curing perineum rupture of postpartum mothers at General Hospital RSUD Puruk Cahu, Murung Raya District, Central Kalimantan Method: Using Randomised pre-post test control group design, the 21 women suffering from perineum rupture stadium II are grouped into three. The black cumin (nigella sativa) oinment is rubbed on the wound Perineum rupture everyday during seven days of postpartum ranging from treatment group. The evaluation is done in the day 1 (pre test), the day 3, 5 and 7 (post test) by using REEDA scale. Result: The black cumin (nigella sativa) oinment is effective in fastening wound healing of perineum rupture since the day 3. This can be seen from the significantly downgrading score of redness, Oedema, and Ecchymosis compared to control group (p<0,05). The day 5 and 7 show significantly downgrading score of Discharge, Approximation and wound compared to control group (p<0,05). Descriptively, black cumin (nigella sativa) 10% is more effective than 5% in the process of healing perineum rupture on postpartum mothers. Conclusion: The black cumin oinment (nigella sativa) functions in the phase of inflamation by postponing kinin and postglandin forming indirectly, this functions in the phase of proliferation by angiogenesis, collagen, and wound contraction. The black cumin oinment 10% is more effective than 5%. Key words: black cumin (nigella sativa) 5% and 10%, Redness, Oedema, Ecchymosis Discharge, Approximation, and wound

EFEKTIFITAS Guided Imagery and Music (GIM) TERHADAP KADAR HORMON KORTISOL PADA IBU POST PARTUM BLUES DI WILAYAH KOTA SEMARANG

Postpartum blues (PPB) atau sering juga disebut Maternity blues atau Baby blues dimengerti sebagai suatu sindroma gangguan efek ringan yang sering tampak dalam minggu pertama setelah persalinan dan memuncak pada hari ke tiga sampai kelima dan menyerang dalam rentang waktu 14 hari terhitung setelah persalinan. Untuk mengantisipasi ibu postpartum yang mengalami post partum blues perlu diadakan penelitian dengan tujuan untuk mengidentifikasi efektifitas Guided Imagery and Music (GIM) terhadap kadar hormon kortisol pada ibu postpartum blues di Wilayah Kota Semarang. Penelitian ini menggunakan Quasi Experimental atau eksperimental semu dengan rancangan penelitian Pre and post test with control group design. Lokasi penelitian dilaksanakan di wilayah Kota Semarang. Waktu penelitian dilaksanakan bulan Desember 2015- Juni 2016. Sampel penelitian ibu postpartum baik primipara maupun multipara yang mengalami postpartum blues berada di wilayah kerja kota Semarang yang terbagi menjadi 3 bagian, yaitu kelompok kontrol, kelompok musik alam, dan kelompok musik Kenny G dengan masing-masing terdiri atas 12 responden dengan total 36 responden. Hasil penelitian dianalisis menggunakan uji one way anova dan analisis regresi linier. Hasil penelitian menunjukkan bahwa tidak ada perbedaan paritas (p value = 0,441), pendidikan (p value = 0,586), pekerjaan (p value = 0,837), dan dukungan sosial (p value = 0,877) antara kelompok intervensi musik GIM (Guided Imagey and Music) di BPM Wilayah Kota Semarang. Terapi musik GIM Kenny G adalah yang paling efektif menurunkan hormon kortisol. kelompok GIM Kenny G dapat menurunkan skor EPDS sebesar 2,37 dan menurunkan skor post kortisol sebesar 28,95 dibandingkan dengan kelompok kontrol. Sedangkan setiap kenaikan 1 poin skor EPDS maka akan meningkatkan 0,53 skor post EPDS. Selain itu setiap kenaikan 1 skor pre kortisol maka akan meningkatkan 0,75 skor post kortisol. Untuk pre kortisol dan pre EPDS menjadi tidak bermakna terhadap post kortisol dan post EPDS. Kata kunci : paritas, pekerjaan, pendidikan, dukungan sosial, Guided Imagery and Music (GIM) Postpartum blues (PPB) or Maternity Baby blues known as a mild syndrome disorder effects that sometime appears in the first week after delivery and peaked on third or fifth day, and the symptom occur in the span of 14 days after delivery. Based on number of postpartum mothers who experienced post partum blues, there need a study to identify the effectiveness of Guided Imagery and Music (GIM) toward cortisol hormone levels of postpartum blues mother in the city of Semarang. The study used Quasi Experimental or quasi-experimental research design with pre and post-test with control group design. the research conducted in the city of Semarang, on December 2015 to June 2016. The research samples are postpartum mothers both primiparous and multiparous who experienced postpartum blues in BPM Region Semarang and divided into 3 groups, namely a control group, a group of natural music, and music groups Kenny G. Each group consists of 12 respondents with 36 respondents totaly. The results of the study was analyzed using one-way anova test and multiple linear regression analysis. The results showed that there was no difference in parity (p value = 0.441), education (p value = 0.586), occupation (p value = 0.837), and social support (p value = 0.877) between the intervention group music GIM (Guided Imagey and Music ) in BPM Region Semarang. The GIM - Kenny G Music therapy was the most effective lowering cortisol hormone level. The GIM – Kenny G can lowered EPDS score of 2.37 and lowered cortisol post a score of 28.95 compared with the control group. While every increasing of 1 point EPDS score will increase post EPDS score of 0.53. Moreover, any increasing in of 1 point of pre cortisol will increase cortisol post score of 0.75. The pre cortisol and pre EPDS is meaningless towads post cortisol and post EPDS. Keywords : parity, employment, education, social support, Guided Imagery and Music (GIM

Pencegahan Kecurangan (Fraud) sesuai dengan Permenkes No. 36 Tahun 2015 tentang Pencegahan Kecurangan (Fraud) dalam Pelaksanaan Program Jaminan Kesehatan pada Sistem Jaminan Sosial Nasional di Rumah Sakit X

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan 2016 ABSTRAK Lina Umboro Styowati Pencegahan Kecurangan (Fraud) sesuai dengan Permenkes No. 36 Tahun 2015 tentang Pencegahan Kecurangan (Fraud) dalam Pelaksanaan Program Jaminan Kesehatan pada Sistem Jaminan Sosial Nasional di Rumah Sakit X xii + 143 halaman + 8 tabel + 9 gambar +7 lampiran Perubahan pola pembayaran menggunakan CBG menyebabkan perubahan proporsi penerimaan rumah sakit serta perubahan beban resiko keuangan, hal ini yang mendorong timbulnya potensi fraud. Tindakan readmisi di Rumah Sakit X berkisar 29,35% pasien rawat jalan dan 3,6% pasien rawat inap mendapatkan perawatan lebih dari 1 (satu) kali dalam periode 1 (satu) bulan serta belum terciptanya kebijakan pencegahan kecurangan di Rumah Sakit X sebagaimana diamanatkan dalam Permenkes RI No. 36/ 2015. Lima tahapan formulasi dilakukan untuk merumuskan kebijakan, pada penelitian ini hanya melakukan 2 (dua) tahap formulasi yaitu fase pertama berupaya untuk mengidentifikasi tujuan dan program pencegahan kecurangan di Rumah Sakit X dan fase kedua formulasi yaitu menganalisa kelengkapan informasi. Jenis penelitian ini adalah kualitatif dengan menggunakan wawancara dan diskusi mendalam. Informan utama dalam penelitian ini adalah lima koder dan unsur pengambil keputusan. Teknik analisis data dengan analisis konten, meliputi wawancara dengan informan diolah kemudian dilakukan analisis data. Hasil penelitian menunjukkan masih lemahnya pemahaman petugas pelaksana tentang tindakan kecurangan, hal ini ditunjukkan melalui jawaban responden yang memiliki interpretasi berbeda maksud tindakan kecurangan JKN berdasarkan Permenkes No. 36/2015 serta belum adanya atensi dari pengambil keputusan terkait sistem pencegahan. Atensi dapat diketahui dari perhatian utama pengambil kebijakan hanya pada permasalahan pengkodean diagnosa yang memiliki over cost dan juga belum adanya pembaharuan SK Pengendali Asuransi sejak tahun 2013. Untuk mewujudkan sistem pengendalian efektif yang mampu mencegah, melaporkan dan memperbaiki potensi kecurangan di Rumah Sakit X dengan cara menciptakan program pencegahan dan deteksi dini berupa pendidikan anti fraud, investigasi internal melalui analisa data klaim dan program tindakan pelaporan dan pemberian sanksi. Diperlukan kelengkapan sistem berupa tim pencegahan kecurangan dan pedoman pencegahan yang berisi literature review, daftar tindakan yang dianggap potensi fraud, aspek pencegahan, deteksi dan penindakan serta petunjuk teknis pencegahan fraud, monitoring dan evaluasi serta pelaporan. Penelitian ini merekomendasikan untuk menerbitkan SK Tim Pencegahan Kecurangan , merumuskan draf final pencegahan kecurangan agar dapat disahkan menjadi pedoman pencegahan kecurangan, pengembangan sistem informasi untuk analisa data klaim. Kata kunci : Formulasi Kebijakan, Pedoman Pencegahan Kecurangan, Fraud Kepustakaan: 52 (2000-2015) Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Administration and Health Policy 2016 ABSTRACT Lina Umboro Styowati Fraud Prevention based on the Health Minister Regulation Number 36 in 2015 about Fraud Prevention in the Implementation of the Health Insurance Program on the National Social Insurance System at X Hospital xii + 143 pages + 8 tables + 9 figures + 7 appendices The change of a payment pattern using CBG causes the change in the proportion of hospital income and the change in burden of financial risk that will lead to fraud. Readmission to X Hospital was approximately 29.35% of patients at outpatient unit and 3.6% of patients at inpatient unit who got treatment more than one in a month. In addition, there was no policy which referred to the Health Minister Regulation Number 36/2015 to prevent fraud at X Hospital. Five steps of formulation were conducted to arrange the policy. In this study, two of these five steps of formulation namely identifying objectives and a program of fraud prevention at X Hospital as the first step and analysing completeness of information as the second step were conducted. This was a qualitative study by conducting indepth interview. Main informants consisted of five coders and decision makers. Data were collected using a method of content analysis. The result of this study showed that the implementers did not really understand fraud activity. Each officer had different interpretation in defining fraud of JKN based on the regulation. In addition, decision makers did not pay attention to this problem. Attention could be identified from the main attention of policy makers that only focussed on a problem of coding diagnosis which had over cost. The Insurance Control Decree have not been renewed since 2013. To realise the effective control system that could prevent, report, and improve a potency of fraud at the X Hospital, it was conducted by creating a program of prevention and early detection like education of anti-fraud, internal investigation through analysing claim data, reporting, and punishing. There needed to complete system like a team of fraud prevention and a prevention guidance that consisted of a literature review, a list of actions categorised as fraud, aspects of prevention, detection, action, a technical guidance of fraud prevention, monitoring, evaluating, and reporting. The Decree of a fraud prevention team needs to be released. A final draft of fraud prevention needs to be arranged in order to be legalised to be a guidance of fraud prevention. In addition, information system needs to be developed to analyse claim data. Keywords : Policy Formulation; Guidance Of Fraud Prevention, Fraud Bibliography: 52 (2000-2015

Studi Kasus Restrukturisasi Dinas Kesehatan Kabupaten Rembang dengan Pembentukan Cabang Dinas dan Pusat Kesehatan Desa

TERSEDIA DALAM FIL

Pengembangan Manajemen Kinerja Perawat dan Bidan sebagai Strategi dalam Peningkatan Mutu Klinis

TERSEDIA DALAM FIL

ANALISIS FAKTOR-FAKTOR RISIKO KETERLAMBATAN PERKEMBANGAN ANAK BALITA DI KABUPATEN KUDUS

LatarBelakang :Data balita mengalami keterlambatan perkembangan di Kudus sebanyak 186 kasus (0,2 %). Banyaknya faktor yang berpengaruh terhadap keterlambatan perkembangan anak perlu analisis agar sumber daya manusia di Indonesia lebih berkualitas. Tujuan penelitian ini untuk membuktikan faktor pranatal, perinatal dan pascanatal merupakan faktor risiko terjadinya keterlambatan perkembangan anak balita. Metode :Jenis penelitian observasional dengan rancangan kasus kontrol. Populasi semua balita usia 36-60 bulan yang mengalami keterlambatan perkembangan, Populasi kontrol semua balita usia 36-60 bulan yang perkembangannya normal, jumlah sampel 35 kasus dan35 kontrol. Faktor risiko yang diteliti riwayat status umur ibu risiko tinggi saat hamil, riwayat status gizi ibu dengan KEK saat hamil, riwayat frekuensi kunjungan ANC yang = 4x, riwayat masa gestasi = 37 minggu dan = 42 minggu, riwayat persalinan dengan tindakan,riwayat berat badan lahir tidak normal, riwayat status gizi balita kurang, riwayat tidak diberikannya ASI eksklusif. Pengumpulan data dengan pengisian kuesioner, penilaian perkembangan balita dengan KPSP. Data dianalisis secara univariat, bivariat dan multivariat. Hasil :Faktor risiko yang bermakna adalah riwayat status umur risiko tinggi ibu saat hamil (p-value = 0,05) dengan nilai OR 11,8, dan riwayat tidak diberikan ASI eksklusif dengan nilai p 0,016 dan OR= 3,3. Sedangkan analisis multivariat menunjukkan bahwa faktor riwayat umur ibu risiko tinggi saat hamil dengan B 2,137 Adjusted OR 8,476, CI 0,53 dan p-value 0,969-74,177. Kesimpulan : Faktor risiko riwayat umur ibu risiko tinggi saat hamil dan riwayat tidak diberikannya ASI eksklusif adalah yang terbukti merupakan faktor risiko terjadinya keterlambatan perkembangan balita di Kabupaten Kudus. Saran kepada ibu perlu mempersiapkan diri dari mulai kehamilan dan memperhatikan perkembangan anaknya dengan memeriksakan ke tenaga kesehatan secara rutin, sehingga deteksi dini pertumbuhan dan perkembangan balitanya dapat terpantau. Kata Kunci : Faktor risiko, keterlambatan perkembangan balita Background :Based on the data found from the survey of Central Public Health in Kudus Regency, there are 186 problems (0.2 percent) related to the growth retardation of children under five years old. It caused the decreasing of human resources quality. There are many factors influenced the children growth retardation, that is classified into the factors of prenatal, perinatal and pascanatal risk. The factors that caused the growth retardation of children under five years old should be studied for further.This study is aimed at proving some factors of prenatal, perinatal, and pascanatal risk as the factors which are influenced on the growth retardation of children under five years in Kudus Regency. Methods:It is a kind of observational study with the control case plan. The population of the study is all the children under five years old around 3660 months who got the children growth retardation. Meanwhile, the control population is all the children under five years old around 36-60 months who got the normal children growth. There are 35 cases and 36 control population. The independent variables are the history of mother’s age with the high risk, the history of mother’s nutrient with KEK when pregnant, the history of ANC frequency more than four times, the history of gestation more than 37 weeks and less than 42 weeks, the history of delivery with special treatment, the history of abnormal weight, the history of non exclusive ASI given to the baby. The dependent variable is the children growth retardation under five years old. The data is collected through questionnaire and the children growth using KPSP. The data is analyzed by univariate, bivariate, and multivariate. Results :The bivariate analysis showed that the factors that related to the children growth retardation under five years old in Kudus regency was the history of the high risk pregnant mother, (p-value more than 0.05) with OR 11.8 and the history of non exclusive ASI given to the baby, (p-value 0.016 and OR 3.3. Conclusion :The society had to know the factors influenced on the children growth retardation under five years old so it can reduce the case. Key words: risk factor, the children growth retardati

Evaluasi Pelayanan Kesehatan Anak di Lembaga Pemasyarakatan Anak Klas II A Blitar Tahun 2014

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Kesehatan Ibu dan Anak 2015 ABSTRAK Anis Zuni Rohmania Evaluasi Pelayanan Kesehatan Anak di Lembaga Pemasyarakatan Anak Klas II A Blitar Tahun 2014 xvi + 106 halaman + 5 tabel + 7 gambar + 17 lampiran Pelayanan kesehatan adalah upaya di bidang kesehatan bagi anak didik pemasyarakatan yang meliputi berbagai upaya promotif, preventif, kuratif dan rehabilitatif yang dilaksanakan pada unit pelayanan kesehatan di Lembaga Pemasyarakatan. Tujuan penelitian ini adalah untuk melaksanakan evaluasi pelayanan kesehatan berdasarkan aspek input, proses dan output di lembaga pemasyarakat anak Klas II A Blitar. Penelitian ini menggunakan metode kualitatif explanatory research. Pengumpulan data dilakukan dengan wawancara mendalam pada informan utama yang terdiri dari perawat poliklinik, kepala sub sie bimkemaswat. Informan triangulasi antara lain kepala lapas, kepala sub bagian TU, Kader dan Andikpas dengan kriteria evaluasi pada input, proses dan output sesuai dengan standar yang ditetapkan oleh Dirjen Bina Kesehatan Masyarakat. Hasil penelitian adalah sebagai berikut: dari segi input terdapat ketidaksesuaian dengan pedoman pelayanan kesehatan seperti SDM pelayanan kesehatan terbatas pada satu orang perawat, dana untuk pelayanan kesehatan di lapas berasal dari pemerintah pusat sedangkan dana pelayanan rujukan atau rawat inap belum oleh BPJS namun ada dana dari Pemerintah Propinsi, sarana prasarana sudah ada namun perlu diatur pemakaiannya agar seimbang dengan jumlah andikpas, pedoman sudah ada namun tidak dapat dilaksanakan sepenuhnya. Dari segi proses terdapat ketidaksesuaian dengan pedoman pelayanan kesehatan anak baik dari dimana perencanaan tidak dilakukan, pengorganisasian tidak dapat terlaksana karena jumlah SDM terbatas, pelaksanaan dilakukan dan penilaian dilaksanakan setiap bulan. Dari segi output tidak sesuai dengan pedoman pelayanan kesehatan anak, tidak ada pemantauan status gizi dan pemantauan kecukupan kalori. Kesimpulan dari penelitian ini adalah pelayanan kesehatan anak di lapas anak klas II A Blitar tahun 2014 belum sesuai dengan pedoman yang diterbitkan oleh direktorat jenderal Bina Kesehatan Masyarakat. Berdasarkan hasil tersebut disarankan kepada Direktorat Pemasyarakatan untuk menambah personil terutama di bidang kesehatan. Perlu adanya kerjasama lintas sektor untuk meningkatkan pelayanan kesehatan andikpas sehingga pada akhirnya status kesehatan andikpas terjamin. Kata kunci : Evaluasi, Pelayanan Kesehatan Anak, Lembaga Pemasyarakatan Kepustakaan : 32 (1979 - 2014) Diponegoro University Faculty of Public Health Master’s Program in Public Health Majoring in Maternal and Child Health 2015 ABSTRACT Anis Zuni Rohmania Evaluation of Children’s Health Services at Prison for Children Class II A in Blitar xvi + 106 pages + 5 tables + 7 figures + 17 enclosures Health effort is an effort in health for children at prison consists of promotive, preventive, curative, and rehabilitative implemented in a health service unit at prison. The aim of this study was to implement evaluation of health services based on aspects of input, process, and output at prison for children class II A in Blitar. This study used a qualitative method with explonatory research. Data were collected by conducting indepth interview. Main informants consisted of nurses at polyclinic and head of bimkemaswat sub section. Informants for triangulation purpose consisted of head of prison, head of administrative affairs sub section, cadres, and Andikpas with criteria of evaluation on input, process, and output in accordance with the standard released by Dirjen Bina Kesehatan Masyarakat. The results of this research showed that regarding input, some aspects did not refer to a health service guideline as follows: there was only one nurse working to health services; budget was obtained from Indonesian government whereas budget for referral service or inpatient service was obtained from province government not from BPJS; all facilities were available but the usage needed to be regulated in accordance with number of Andikpas; and a guideline was available but it could not been implemented entirely. Regarding process, some aspects did not refer to the health service guideline as follows: planning was not made; and organising was not conducted due to limited human resource number. However, implementing and evaluating were conducted monthly. Regarding output, some aspects did not refer to the health service guideline as follows: there was no monitoring of nutritional status and monitoring of calorie sufficiency. In conclusion, children’s health services at prison for children class II A in Blitar in 2014 had not been in accordance with the guideline released by Direktorat Jenderal Bina Kesehatan Masyarakat. As suggestions, Direktorat of Pemasyarakatan needs to recruit health workers. There also needs to make cooperation with inter-sector to improve health services of andikpas in order to improve health status of andikpas. Key Words : Evaluation, Children’s Health Services, Prison Bibliography : 32 (1979-2014

Implementation Ff Midwive-Traditional Birth Attendants Partnership by Midwives in Buton District, Southeast Sulawesi, (a Case Study on Wakaokili Primary Healthcare Center)

The limited knowledge on the importance of health workers deliveries, together with someother factors such as economies, social and culture, made traditional birth attendants becamea choice of delivery services. This condition resulted in the increase of Maternal MortalityRate in Buton District. The coverage of health workers deliveries in Wakaokili was still low. Itwas marked by the low rate of traditional birth attendance-midwives' partnership anddeliveries referral to the midwives, as well as high rates of traditional birth attendancedeliveries. This study was a descriptive qualitative study. Data were collected by in depthinterviews on 4 village midwives and 9 traditional birth attendants as the main informants.Data were analyzed by content analysis method. Results showed that the goals and programsuccess indicators were not understood well. Dissemination was only an introduction and thereport was not discussed. There was no coaching or internship program. The attitude tendedto be ambivalent and the resources were not supportive. It is proven that economic, social andpolitical environment influence the program results