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Keywords: Musca domestica; synanthropic flies; mechanical transmission; soil-transmitted helminth Introduction Indonesia is a tropical temperate developing country with a wide range of problems, one of which is a health problem caused by intestinal infections. Globally it is known that worm infections and intestinal protozoa are important problems for public health (2). This type of worm infection transmitted by soil is ascariasis, trikuriasis, and mine worms, which can cause clinical disorders in humans. A child living in a poor area is likely to be infected with one of three types of worms transmitted by land (4). Worm infections can lead to another significant illness in infected individuals, among them being the cause of impaired cognitive growth, physical disorders and anemia in children. Similar research has also been conducted in North Jakarta in 2017 and the results found there are worm infections A. One of the places that has the risk of helminthiasis disease is where fish landing. Environmental conditions in the place of fish landing is poor environmental sanitation, often occurs flooding this into one of the factors that are vulnerable to helminthiasis disease. In addition, the population density is still high and the number of flies cannot be kept away from the fish landing site. Corresponding Author: Dewi Susanna Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, Jawa Barat 16424, Indonesia e-mail: dsusanna2@yahoo. At least 44 samples in total, because of this study using hypotheses of different proportions, the number of samples doubled from a large sample to a minimum of 88 samples. To anticipate that there is an exclusion of research subject, it needs to be added 10% from the number of samples obtained so that the total sample of 97 people. Samples were taken using method probability sampling method with cluster sampling technique. Based on the samples obtained, questionnaires will be conducted with questionnaire interviews and stool sampling, so the sample of feces as the number of elementary school children is the subject of research to be conducted at home interviews. After the research, the results of the research will be processed using the data analysis program Univariat. Age group categories are divided into two by looking at median value results in the research data obtained, cut off point for age the using median value because of abnormal variable age data distribution. Mother education in this research is distinguished into two groups namely higher education and low education. The number of respondents with a low education of mothers has a more percentage than higher education respondents with a low percentage of education of 82. If viewed from the social economic condition respondents are more at a low socioeconomic level where the opinion of the family is still below the average income of other respondents is Rp. Table 2: Distribution of flies and helminthiasis density Variables Density of flies Infections of worm eggs Source: primary data Category Low High Positif Negatif Total N (97) 30 67 92 5 Percentage (%) 30. Because in this research samples of feces elementary school age children who are positively infected helminthiasis only as many as 5 samples then the analysis of this quantitative research data can not be continued into sufficient or multivaariate analysis. Table 3: Distribution of risk factors for helminthiasis disease in elementary school age children in Muara Angke year 2019 Variables Washing hands Nail hygiene Habits of wearing footwear Access of latrines Floor Conditions Food Sanitation Source: primary data Category Good Bad Clean Not Clean Good Bad Good Bad Good Bad Good Bad Total N 16 81 53 44 45 52 32 65 18 79 18 79 Percentage (%) 16. Most of the respondents had the habit of not wearing a footwear of 52 children (53. This research shows that respondents who access the bad bridge were as much as 65 respondents (67. The condition of the House floor of respondents showed that most of the respondents had poor home floor conditions of 79 respondents (81. As for food sanitation shows most of the respondents had poor food sanitation of 79 respondents (81. Bivariate analysis In this study is not possible because it is caused by a homogeneous dependent variable data. Discussion High density of flies at home respondents could be due to the distance of housing or settlement close to the place of fish processing, so that flies easily breed and stay in the House of citizens.

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Before, in 1893 Caldwell did mention about endonasal approach in lacrimal surgery. A total of 50 cases from otorhinolaryngology and ophthalmology having epiphora were enrolled in the study. Results: There were 12 male and 38 female, epiphora was commonest symptom in all cases and the least common was redness and swelling of eyelid in 1. In 1904 the surgical modality by way of external dacryocystorhinostomy was first performed by Addeo Toti. Observation and Results Amongst 50 cases, there were 12 male (24%) and 38 female (76%) in the ratio of 1: 3. Most of the cases 15 (30%) were of age between 51-60 years and the least 5 (10 %) belonged to the age group of 2030 years. Amongst all cases the commonest presenting symptom (table-2) was watering of eyes in 50 (100 %), followed by pain in lower corner of the eye in 38 (76 %), swelling at medial canthus in 33 (66 %) and lacrimal abscess in 2 (4%) cases, whereas the least common symptom was redness and swelling of eyelid consequent to preseptal cellulitis in 1 (2%) case. The mean duration between first surgery and revision surgery amongst all cases was 5. All pregnant or lactating mothers, previous nasal injury at ostium site, neoplastic lesions of nose and lacrimal apparatus and known cases of immunodeficiency were excluded from the study. In all cases demographic characteristics, clinical history and past medical history etc were recorded. The nose and eye examination for any obvious deformity, turbinate hypertrophy, nasal polyposis, watering or purulent discharge in the medial canthal area etc. At revision endoscopy as a part of corrective surgery additional causes like inadequate size of ostium, inadequate sac marsupialization, cicatricial closure of ostium etc. After revision surgery during immediate follow up the crust were looked for and removed. Patency check of new stoma was made in all cases by syringing weekly for 1 month, monthly for 3 months and then at 6 month. Statistical Analysis: Using statistical analysis the frequency distribution of collected data was obtained Table 2: Distribution of cases according to their symptoms Signs and Symptoms Watering of eyes Local pain Swelling of medial canthus Lacrimal abscess Redness and swelling of eyelid Number of Cases 50 38 33 2 1 Percent 100 76 66 4 2 Indian Journal of Public Health Research & Development, March 2020, Vol. The majority of the study participants belonged to the age group of 51-60 years i. In the similar study by Dave et al the epiphora is commonest presentation in 100% of cases. Further, in this study the intranasal synechia and ostium malposition in 18 (36%) each, ostium stenosis 13 (26%), common canalicular obstruction 11 (22%) and deviated nasal septum 8 (16%) were the additional causes. Our findings was not in accordance with the study by Goyal R et al which could be due to almost double the period of follow up and sample size in their study. However, no such complications mentioned by Goyal R et al were noted in this study. Acknowledgements: We sincerely thank the departments of ophthalmology, radiology and anesthesiology for their cooperation during management of cases in this study. We are thankful to institutional research department for rendering financial support during the study. This study was undertaken after prior ethical clearance from institutional ethics committee, vide letter No. Two new operations for obstruction of the nasal ductwith preservation of the canaliculi and an incidental description ofa new lachrymal probe. Analysis of 104 Cases of Endonasal Dacryocystorhinostomy in a Tertiary Care Hospital: A Prospective Study. Success rates in powered endonasal revision surgery for failed dacryocystorhinostomy in a tertiary referral center. Methodology: Cross sectional quantitative study design with convenient sampling was used. This study involved 20 children diagnosed with Autism Spectrum Disorder aged 5-6 from special School in and around Chennai. Result: Significant relation were found between social responsiveness scores and each of the six sensory system profile scores for children with Autism Spectrum Disorder Conclusion: Atypical sensory responsiveness pattern is predominant in children with Autism Spectrum Disorder. Keywords: Sensory responsiveness, Autism Spectrum Disorder, Primary schools, special schools.

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Mechanical ventilation should also be considered with ventilatory failure, which can result from an increased load on the respiratory system-often manifested by lactic acidosis or decreased lung compliance. Mechanical ventilation may decrease respiratory work, improve arterial oxygenation with improved tissue O2 delivery, and reduce acidosis. Neuromuscular blocking agents should be used with caution because a myopathy associated with prolonged weakness can result. Prognosis worsens with increased duration of organ failure and increased number of organ systems involved. Pulmonary artery (Swan-Ganz) catheters can provide pulmonary artery pressure, cardiac output, and systemic vascular resistance measurements. Thus, routine pulmonary artery catheterization in critically ill pts is not recommended. The inspiratory airway resistance is calculated as the difference between the peak and plateau airway pressures (with adjustment for flow rate). Increased airway resistance can result from bronchospasm, respiratory secretions, or a kinked endotracheal tube. Lowdose dopamine treatment does not protect against the development of acute renal failure. Management depends on determining its cause, alleviating triggering and potentiating factors, and providing rapid relief whenever possible. Referred pain results from the convergence of sensory inputs from skin and viscera on single spinal neurons that transmit pain signals to the brain. Noxious stimuli activate the sensitive peripheral ending of the primary afferent nociceptor by the process of transduction. Inputs from frontal cortex and hypothalamus activate cells in the midbrain that control spinal pain-transmission cells via cells in the medulla. Psychological evaluation is key; behaviorally based treatment paradigms are frequently helpful. The combination of the anticonvulsant gabapentin and an antidepressant such as nortriptyline may be effective for chronic neuropathic pain. Two forms of severe malnutrition can be seen: marasmus, which refers to generalized starvation that occurs in the setting of chronically decreased energy intake, and kwashiorkor, which refers to selective protein malnutrition due to decreased protein intake and catabolism in the setting of acute, life-threatening illnesses or chronic inflammatory disorders. Enteral therapy refers to feeding via the gut, using oral supplements or infusion of formulas via various feeding tubes (nasogastric, nasoduodenal, gastrostomy, jejunostomy, or combined gastrojejunostomy). Yes What are the fluid, energy, mineral, and vitamin requirements and can these be provided enterally? In acute blood loss, hematocrit may not accurately reflect degree of blood loss for 48 h until fluid shifts occur. Removal of leukocytes reduces risk of alloimmunization and transmission of cytomegalovirus. One unit elevates the count by about 10,000/ L if no platelet antibodies are present as a result of prior transfusions. Leukapheresis is replacing bone marrow aspiration to obtain hematopoietic stem cells. About 70% of deaths occur in people who have a condition that is known to be leading to their death; thus, planning for terminal care is relevant and important. Optimal care depends on a comprehensive assessment of pt needs in all four domains affected by illness: physical, psychological, social, and spiritual. Physicians must be clear about the likely outcome of the illness(es) and provide an anticipated schedule with goals and landmarks in the care process. When the goals of care have changed from cure to palliation, that transition must be clearly explained and defended. Ensure that the medical information is as complete as possible and understood by all relevant parties. Advance Directives Only 29% of pts (and less than one-third of physicians) have executed advance directives that define the level of intervention the pt is willing to accept.

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Identify situations in which systemic antifungal therapy is warranted in patients with candiduria. Determine appropriate situations to use echinocandins for invasive Candida infections. Management and treatment of specific syndromes: vaginal discharge (bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis). Treatment of vaginitis caused by Candida glabrata: use of topical boric acid and flucytosine. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for Candidal vaginitis. Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis. Postoperatively, the patient initially did well and diet was restarted on postoperative day 3. On postoperative day 5, the patient started complaining of increased intra-abdominal distention and increased pain. The patient had free air on her x-ray and was taken to the operating room for exploratory laparotomy, where she was found to have a pancreatic head necrosis and abscess and peritonitis. The patient remained intubated postoperatively on propofol and was started on piperacillin-tazobactam, gentamicin, metronidazole, and phenylephrine for a septic appearance (Tmax = 38. It was determined that she had a duodenal stump leak, which was controlled via the right upper abdominal percutaneous drain. What feasible pharmacotherapeutic alternatives are available for treating this infection? Her requirement for phenylephrine to maintain her blood pressure (around 110/60) has been titrated down. Predictive factors of mortality due to polymicrobial peritonitis with Candida isolation in peritoneal fluid in critically ill patients. They also ordered an ophthalmology consult to check her for Candida endophthalmitis. She will require surgical re-exploration when more stable and when her nutritional status is improved. Determine appropriate situations to use vancomycin in empiric antimicrobial regimens for the treatment of febrile neutropenic episodes. Describe situations in which antibiotic monotherapy versus combination therapy would be warranted in the empiric treatment of febrile neutropenia. Does the switch from fluconazole to caspofungin make good clinical sense in this patient after seeing the susceptibility report? He underwent a second course of chemotherapy 5 days ago with liposomal doxorubicin and cyclophosphamide for hormone-refractory disease. Describe situations in which antifungal "prophylaxis" may be beneficial in the surgical intensive care setting. Discuss treatment options for patients with candidemia and Candida endophthalmitis. What information (signs, symptoms, laboratory values) indicates the presence or severity of each of the drug therapy problems? Review the criteria for classification of febrile neutropenic patients as either "low" or "high" risk. What types of neutropenic patients would be considered "low risk" and might benefit from oral antibiotic regimens? Perform a literature search to review the available data on the use of extended-interval aminoglycoside dosing in febrile neutropenia. Is there evidence to support the use of high-peak, extendedinterval aminoglycoside dosing in the empiric treatment of febrile neutropenia? What feasible pharmacotherapeutic alternatives are available for treating this febrile episode? What drug(s), dosage form(s), dose(s), schedule, and duration of therapy are best for the empiric treatment of this febrile episode in this patient? Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for fever with neutropenia: systematic review and meta-analysis. The team added vancomycin 1 g Q 12 h at this point, stopped ciprofloxacin, and had the central line removed. Discuss the timing of antimicrobial prophylaxis for surgery, including doses prior to surgery and dosing after surgery.

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A urethral discharge could be apparent in patients with sexually transmitted infections. Findings consistent with viral infections are present with mumps (rare with vaccine) or other viral infections. Do Gram stain of urethral exudate or first void urine (5 ml) for polymorphonuclear leukocytes, if <35. Imaging If symptoms do not improve within 3 days of antibiotic therapy or if complications occur during the course of epididymitis, do ultrasound. Orchitis and Epididymitis Testicular infarction or tumors such as lymphoma can cause 1091 swelling. External infection of scrotum with Candida can occur in immuno- compromised or diabetic patients. If <15 years of age with no evidence of urinary tract infection, observe without specific treatment. General Measures Bed rest, scrotal elevations, analgesic, and local ice packs are helpful. If evidence of chronic granulomatous infection, do biopsy of epididymal tissue and administer appropriate antituberculous or antifungal therapy. Side Effects & Contraindications Ceftriaxone r absolute: penicillin hypersensitivity. Doxycycline Side effects: nausea, vomiting, diarrhea, photosensitivity and rarely liver function abnormalities Contraindications: r absolute: hypersensivity to tetracycline r relative: patient unlikely to be compliant Side effects: rare allergic reactions Contraindications: 1092 Orchitis and Epididymitis Levofloxacin Osteoarthritis Side effects: gastrointestinal upset, diarrhea, rare skin rash and Contraindications: mental status changes in the elderly r absolute: If patient has sexual contact with persons from Southeast Asia or sexual contact in Hawaii, California, or New England or is a male who has sex with males (resistant gonococci) follow-up During treatment, patient should be examined at 3 days and re- evaluated if failure to improve. Persistent swelling after antimicrobial therapy could be evidence of chronic epididymitis due to Mycobacteria or fungal infections. Patients with epididymitis due to sexually transmitted organisms should refer all sex partners within the last 60 days for examination and treatment and avoid sexual intercourse until therapy is completed. Rarely, abscess formation, pyocele, testicular infarction, chronic epi- didymitis occur. Aortic and mitral insufficiency very infrequent tests Imaging Wormian bone (unmineralized cranial occipito-pareital islands) in 60% of infants or young children. Osteogenesis Imperfecta Osteomalacia and Rickets 1099 Bisphosphonate therapy, oral (alendronate, residronate) or intra- venous (pamidronate; zoledronic acid not reported): decreases fracture rate, increases bone density in children. In adults may increase bone density transiently, but effect on fracture rate not defined. Osteomyelitis associated with vascular insufficiency and diabetes requires some form of amputation in up to 50% over long term. Hematogenous osteomyelitis has excellent prognosis, but inadequate or delayed therapy can result in chronic disease. Presence of a single compression fracture increases subsequent fracture risk 5-fold. Diseases should include: choledocholithiasis cholangiocarcinoma Pancreatic Cancer bile duct strictures sclerosing cholangitis 1127 management What to Do First Initial assessment is directed toward whether the lesion is resectable. Palliation r surgery r endoscopic stent placement duodenal obstruction r surgery. Average 5-year survival is <5% for all patients and 17% with localized resectable disease. Symptoms and Signs Because of improved imaging techniques, pancreatic cysts are often incidentally found. Abdominal or back pain Weight loss Early satiety Nausea and vomiting tests no standard approach to pancreatic cysts has been established. There is currently no definitive approach aside from surgical resection to determine whether a cyst represents a neoplastic lesion. Most often, the goal is to differ- entiate mucinous cystic tumors from serous cystadenomas. Differentiation between different cyst types is often difficult to distinguish from each other prior to resection. Surgical outcomes of pancreatic resections are much better in institutions where the volume is high and the necessary expertise is present. Eczema management What to Do First Assess the risk factors such as trauma, exposure to excess moisture.

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Assess for presence of Taenia solium in bowel by stool exam and asking about passing segments (eggs not always seen on stool exam). General Measures Control seizures with anticonvulsants, and hydrocephalus with steroids and possible shunting. Cysticercosis 457 specific therapy Indications Treat patients with viable cysts (those without ring enhancement) and signs of mass effect. Treatment of patients with cysts in stages of degeneration, with or without focal symptoms or seizures, is controversial. Side Effects & Complications Death of cysts can cause inflammation, headache, seizures. Control this with dexamethasone, and taper, or administer steroids prophylactically (especially with large number of cysts). Contraindications to treatment: absolute: dead, calcified cysts Contraindications to treatment: relative: asymptomatic patients with viable or degenerating cysts (this is a controversial area) follow-up During Treatment Observe for headache, seizures, altered consciousness, due to sudden death of parasites. Cystitis and Pyelonephritis Lower urinary tract infections present with dysuria, urgency, and 459 frequency. In males, prostate exam should be considered to rule out prostatitis (gently if acute prostatitis expected). In women, pelvic exam should be considered to rule out cervicitis, pelvic inflammatory disease. Bladder palpation and percussion should be used to assess for uri- nary retention. Generally, do not treat asymptomatic bacteriuria (pregnancy, kidney transplant, immunocompromise, anatomic abnormalities, impending surgery are exceptions to this rule; bladder catheter is not an exception). Complicated urinary tract infections (anatomic abnormality, obstruction, hospital-acquired organism, indwelling bladder catheter) require at least 10 days of therapy. Urinary tract infections in men are always considered complicated (and require evaluation of genitourinary anatomy; stongly consider Urology consultation). Whenever possible, Gram stain should be used to guide empiric choice of antibiotics. Community acquired Gram-negative infections generally respond to third-generation cephalosporins, quinolones, and trimethoprimsulfamethoxazole. Ampicillin (or vancomycin for hospital-acquired organisms) is the agent of choice for Enterococccus sp. Linezolid is effective for Vancomycinresistant enterococci but should be reserved for severe or lifethreatening infections. Hospital-acquired urinary tract infections may require antipseudomonal penicillin with or without a beta-lactamase inhibitor, ceftazidime, imipenem, aztreonam, or quinolone therapy. For resistant Candida sp, a single dose of amphotericin B has been found effective in some patients. Liposomal formulations of amphotericin do not penetrate the renal parenchyma or bladder and should not be used. Prolonged fever; malaise, myalgia, pharyngitis, hepatos- 462 Cytomegalovirus tests Nonspecific Moderate elevation of transaminases Lymphocytosis with atypical monocytes Negative heterophils Specific Non-congenital: difficult due to increase number of asymptomatic infection and relapsing infection. Flesh-colored, erythematous or hyperpigmented papule or nodule with little surface change When the lesion is pinched, it will dimple centrally. Other tests: None differential diagnosis All causes of mild diarrhea management What to Do First Nothing General Measures None specific therapy Indications Symptomatic patients Treatment Options Iodoquinal for 3 weeks. Contraindications to treatment: absolute: allergy to medications Contraindications to treatment: relative: asymptomatic patient follow-up Routine Repeat stool examination if symptoms persist. Diphtheria Disorders of Neutrophil Function 489 Patients should be immunized with diphtheria toxoid, since toxin is so potent that disease itself may not be immunizing. Close contacts should receive therapy with erythromycin for 7 d and have cultures 2 wks after completion of therapy to ensure eradication of the carrier state; close contacts should also be immunized if immunization status unclear or immunizations not up to date.

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Treatment of epilepsy in women of reproductive age: pharmacokinetic considerations. Recommend drugs of choice and alternative therapies for different types of seizures. Which clinical and laboratory parameters are needed to evaluate the therapy to ensure the best possible outcome and minimize adverse events? What information should be discussed with the patient to ensure successful therapy and to minimize adverse effects? Write a concise paper outlining the current recommendations for assisting a person who is having a seizure. Perform a literature search to identify articles that concluded that seizure medications can be withdrawn after a certain seizure-free interval. Perform a literature search to identify articles that outline the advantages and disadvantages of the ketogenic diet to prevent seizures. The attendant reported that Mary had a 27-second seizure at 6:30 this morning while she was being bathed. Her history is also significant for recurrent aspiration pneumonia, chronic bacteriuria, and chronic intermittent ileus. Over the years, she has experienced progressive physical deterioration and is presently unable to sit, stand, or walk and is totally dependent on others for all of her needs. Seizures have been present since an early age, but the exact date of onset is unknown. Anticonvulsants used in the past include phenobarbital (withdrawn due to ineffectiveness), carbamazepine (withdrawn due to hyponatremia), valproic acid (withdrawn due to abnormal liver enzymes), and topiramate (withdrawn due to ineffectiveness). She receives all of her nutrition and medication via a gastrostomy tube that was placed secondary to her neurogenic swallowing disorder and subsequent numerous aspiration pneumonias. If requirements for a regular license are not met, many states allow individuals with seizures to hold a restricted license, which would allow driving under certain conditions, such as only during daytime, only to and from work within a certain distance from home, or only during an emergency. Commission on Classification and Terminology of the International League Against Epilepsy. Practice parameter: management issues for women with epilepsy (summary statement). What is the best pharmacotherapeutic plan for this patient to treat status epilepticus? What clinical and laboratory parameters are needed to evaluate the therapy to ensure the best possible outcome? What patient-specific factors can interfere with phenytoin levels, and what can the patient (or those who care for her) do to minimize them? Identify the advantages of using lorazepam in status epilepticus, and perform a literature search to identify articles that support its use over diazepam. Write a concise paper outlining the proper procedure for administering Diastat to a person in status epilepticus. Prepare a short paper summarizing the hematologic adverse effects of all of the antiepileptic drugs. Women with epilepsy who take antiepileptic drugs may consider self-discontinuing their medication when they become (or want 160 to become) pregnant. Describe the potential risks to the mother and baby from antiepileptic drugs and from uncontrolled seizures. Witnesses report that he was initially lethargic and in severe pain at the scene and has become progressively less responsive since the incident. Intravenous valproate is well tolerated in unstable patients with status epilepticus. Upon painful stimuli, he does not speak or open his eyes but does exhibit extensor posturing. The left pupil is 6 mm and nonreactive, and the right pupil is 3 mm and slowly reactive. Inspection and palpation around the eyes reveal multiple orbital fractures with crepitus. The head has an open 4-cm scalp laceration over the left frontal region of the skull with some swelling. Discuss the therapeutic management of traumatic brain injury and increased intracranial pressure associated with acute brain injury.

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Besides, non-verbal communication was important in interaction among team members to improve nonaccidental messages, and it might lose those fault messages(30). This factor probably was the cause of negative correlation and insignificant result of influence of communication variable toward team cohesion. Clark dan Krych (2004) stated that communication ability from a leader to staffs will determine whether the employee will make a mistake or not(23). If communication skill was not good, it would be interpreted in a different way among team members. The district health office might enhance intrinsic reward by giving a training of internal positive feedback for the head of community health center. Source of Funding: Department of Health and Administration Policy, Public Health Faculty, Airlangga University, Surabaya, Indonesia Ethical Clearance: There search has been approved by Ethical Commission of Nursing Faculty, Airlangga University (No. All respondents were given explanation and information including the purposes,method, and also had signed informed consent forms. Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: Feasibility and early outcomes. Assessing the Cohesion of Teams; Validity of the Group Environment Questionnaire. The Influence of Responsibility, Developmentand RecognitionTowardPerformance of the Employees in Sula District Agriculture Service. The Resilient Organization: A Meta-analysis of the Effect of Communication on Team Diversity and Team Performance Authors. Creating an Engaged Workforce: the Impact of Authentic Leadership, Transparent Organizational Communication, and Work-Life Enrichment. Effects of Group Communication Cohesion of Staff and Cluster Analysis in a Multi Campus University. Examining Project Commitment in Cross-Functional Teams; Antecedents and Relationship with Team Performance Examining Project Commitment in Cross-Functional Teams; Antecedents and Relationship with Team Performance. The Influence of Intrinsic and Extrinsic Rewards on Employee Results; An Empirical Analysis in Turkish Manufacturing Industry. The portrait of the use of the National Health Insurance can be seen from the number of visits which increase each year. The increase in patient visits at local health center makes the local health center employees overwhelmed with a lot of tasks. Based on the initial survey at the Keputih Health Center, it was found that the burnout rate of employees in 2018 was 50. The purpose of this study was to analyze the effect of burnout on employee job satisfaction in 9 local health centers in Surabaya. The population of this research is all employees of the Surabaya City Health Center who provide services for patients directly every day. The results showed that the likelihood of respondents with high burnout would have a higher job satisfaction 5. The conclusion is that low burnout will leads to the possibility of higher job satisfaction. Indonesia has taken a significant step by using the National Health Insurance which is an amalgaation of various forms of health insurance which have been applied previously. The portrait of the utilization of the National Health Insurance can be seen from the number of visits which increase every year. The implementation of National Health Insurance in all regions, including the rempte areas and borders, must be balanced with equitable distribution of human resources and the fulfillment of the availability of health care facilities2. Average Monthly Patient Visits in 20162018 at Keputih Health Center Surabaya the Surabaya city has 63 health centers in total which spread all over the region. The national health 1280Indian Journal of Public Health Research & Development, March 2020, Vol. The Gatekeeper means it is the first level of health service facility and place of contact for patients that can be used to reduce the possibility of patient referrals to an advanced health facilities and it is function as an effort to control quality and costs3. The increase in the average visit of these patients consequently increases the workload of employees in the local health centers which leads to possibility of burnout. Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism, and inefficacy. Exhaustion is the central quality of burnout and the most obvious manifestation of this complex syndrome. Depersonalization is an attempt to put distance between oneself and service recipients by actively ignoring the qualities that make them unique and engaging people.


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