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Weight gain in contraceptive implant acceptors can have various negative health impacts, including degenerative diseases such as heart disease, hypertension, and a reduced ability to carry out daily activities. This study aimed to examine the relationship between the duration of contraceptive implant use and weight gain among women of reproductive age. A quantitative design with a cross-sectional approach was applied. The study population consisted of all contraceptive implant acceptors registered at the health facility, totaling 74 respondents. The sampling technique used was random sampling to ensure representativeness. The independent variable in this research was the duration of contraceptive implant use, while the dependent variable was weight change. Data were collected using a structured questionnaire, and statistical analysis was performed using the chi-square test. The results revealed a statistically significant relationship between the duration of contraceptive implant use and weight gain among respondents. Specifically, the longer the duration of implant use, the higher the likelihood of experiencing weight gain. This finding supports existing evidence that hormonal contraceptive implants may cause side effects, including increased body weight. If not properly managed, such weight gain can lead to overweight or obesity, conditions that substantially raise the risk of developing metabolic disorders such as diabetes mellitus, as well as cardiovascular diseases including hypertension and coronary heart disease. Based on these results, it is recommended that contraceptive implant users undergo regular weight monitoring to identify changes early. Additionally, health education programs emphasizing balanced nutrition and adequate physical activity should be implemented for women using hormonal contraceptives. Health care providers are encouraged to deliver comprehensive counseling prior to implant insertion, ensuring that potential side effects and preventive measures are clearly explained. Such proactive steps will help women make informed decisions and maintain optimal health while using contraceptive implants.

Indonesia's healthcare system continues to face significant challenges in delivering equitable services across diverse and remote regions. The digital transformation of healthcare—through the integration of Artificial Intelligence (AI), big data, and telemedicine—offers promising solutions to overcome disparities in access, infrastructure, and service delivery. This study aims to comprehensively analyze global and national research trends related to the digital transformation of healthcare using a Systematic Literature Review (SLR) approach, supported by bibliometric analysis through the VOSviewer software. Following the PRISMA protocol, a total of 30 relevant articles published between 2020 and 2025 were identified and analyzed. The network and overlay visualizations generated reveal four major thematic clusters: digital transformation and service quality, big data and pandemic response, AI and data privacy, and community engagement in digital health services. Overlay visualization also shows a clear shift in research focus—from early pandemic responses toward system optimization, ethical governance, and technological inclusivity in recent years. The findings highlight that digital healthcare transformation has increasingly evolved from emergency responses to COVID-19 into a strategic framework for long-term system improvement. Moreover, AI and big data have played pivotal roles in enhancing diagnostics, predicting outbreaks, and improving resource allocation. However, concerns related to privacy, digital literacy, and unequal technological access remain prominent. The study concludes that the integration of AI, big data, and telemedicine not only enhances healthcare efficiency but also requires strong regulatory frameworks, infrastructure readiness, and public engagement. Future research should incorporate co-citation and cross-country comparative analyses to enrich the understanding of digital health transformation in a global context, especially in low- and middle-income countries like Indonesia.

Indonesia's healthcare system continues to face significant challenges in delivering equitable services across diverse and remote regions. The digital transformation of healthcare—through the integration of Artificial Intelligence (AI), big data, and telemedicine—offers promising solutions to overcome disparities in access, infrastructure, and service delivery. This study aims to comprehensively analyze global and national research trends related to the digital transformation of healthcare using a Systematic Literature Review (SLR) approach, supported by bibliometric analysis through the VOSviewer software. Following the PRISMA protocol, a total of 30 relevant articles published between 2020 and 2025 were identified and analyzed. The network and overlay visualizations generated reveal four major thematic clusters: digital transformation and service quality, big data and pandemic response, AI and data privacy, and community engagement in digital health services. Overlay visualization also shows a clear shift in research focus—from early pandemic responses toward system optimization, ethical governance, and technological inclusivity in recent years. The study concludes that the integration of AI, big data, and telemedicine not only enhances healthcare efficiency but also requires strong regulatory frameworks, infrastructure readiness, and public engagement. Future research should incorporate co-citation and cross-country comparative analyses to enrich the understanding of digital health transformation in a global context.

Picky eating is a prevalent issue among preschool children, often leading to nutritional deficiencies, disrupted growth, and increased parental stress. This systematic literature review aims to explore the management of picky eating through complementary and alternative therapies (CAT) and compares these findings with contemporary interventions. Picky eating behaviors can significantly affect children’s eating patterns, leading to challenges in maintaining a balanced diet. Although traditional medical interventions focus on behavioral modification and nutritional counseling, many parents are seeking alternative approaches to manage these behaviors in a more holistic and natural manner. This review encompasses studies published between 2015 and 2025, sourced from PubMed, Scopus, and Google Scholar, using keywords such as "Alternative Therapy," "Picky Eating," and "Preschool Children." The review population consists of 20 articles, and the sample includes 5 selected studies that meet the criteria for evaluating the effectiveness of complementary and alternative therapies in managing picky eating behaviors. Data analysis utilized thematic analysis, with the findings analyzed thematically to draw conclusions regarding the efficacy of CAT. The results indicated that mindfulness practices, dietary practices, Tuina massage as a traditional therapy, taste exposure, sensory learning, and nutrition education were all effective in reducing picky eating behavior among children aged 1 to 5 years. These approaches not only helped to improve children’s acceptance of a wider variety of foods but also contributed to the reduction of stress for both children and parents. The findings suggest that integrating these alternative therapies into conventional practices can provide a comprehensive and effective strategy to address picky eating in preschool children. Future research is needed to further explore the long-term impacts of these therapies and to identify the most suitable combinations for different individual needs.

Anemia is a global health problem that often occurs in pregnant women. Inadequate pregnancy spacing can contribute to the risk of anemia. This study aims to analyze the relationship between pregnancy spacing and the incidence of anemia in pregnant women. This type of research is observational analytic with a case-control design. This study was conducted from February to October 2024 at a selected health center in the region. The case-control design was chosen to investigate the causes of anemia during pregnancy, particularly focusing on the effects of pregnancy spacing. The number of samples used was 30 cases, while 30 control cases were selected by simple random sampling from a larger pool of eligible pregnant women. The analysis employed the chi-square test to determine the statistical significance of the relationship between pregnancy spacing and the incidence of anemia. Results showed that 21.7% of respondents had anemia, with a significantly higher prevalence in those with a pregnancy spacing of less than two years. After conducting the chi-square test, the result yielded a significant p-value of 0.002, indicating a strong association between short pregnancy intervals and anemia. This finding highlights the potential risks associated with inadequate pregnancy spacing, emphasizing the importance of family planning and prenatal care in preventing anemia in expectant mothers. The study suggests that adequate pregnancy spacing may reduce the incidence of anemia, thus promoting healthier pregnancy outcomes. Furthermore, it underscores the need for educational programs aimed at raising awareness of the benefits of proper pregnancy planning. Such initiatives would not only help prevent anemia but also improve maternal and fetal health. Comprehensive health policies promoting spacing between pregnancies can have long-term positive effects on maternal well-being.

This study aims to analyze the accuracy of ICD-9-CM coding in Cathlab procedure claims submitted to BPJS Kesehatan under the INA-CBGs reimbursement system at RSI Aisyiyah Malang. Accurate coding is critical for determining appropriate claim grouping and tariff calculation within Indonesia’s national health insurance scheme. The research employed a mixed-methods approach, combining quantitative analysis of 244 Cathlab claims from 2024 with qualitative insights obtained through document review, interviews, and direct observation. The results showed that 182 claims (74.59%) were accepted as accurate and complete, while 62 claims (25.41%) were returned as pending. Common causes of claim inaccuracy included missing supporting documents (37.10%), incorrect ICD-9-CM codes (27.42%), and nonspecific diagnoses (19.35%). Procedural miscoding, such as omitting dual catheterization codes or stent-related procedure codes, was identified as a frequent issue, significantly impacting claim grouping and reimbursement. The study highlights systemic challenges related to documentation quality, coder competency, and institutional claim verification processes. These challenges result in delays, incorrect payments, and administrative inefficiencies, posing barriers to effective reimbursement. The findings underscore the importance of implementing Clinical Documentation Improvement (CDI) strategies, improving coder training, and transitioning to newer coding systems such as ICD-10 or ICD-11. Upgrading to these systems will support better coding accuracy, enhance claim processing efficiency, and ensure more appropriate reimbursement. Strengthening these components is essential to ensure the integrity of Indonesia’s health financing system, improve operational workflows, and ensure that healthcare providers receive timely and accurate reimbursement for services rendered. This study provides a comprehensive evaluation of the current state of coding practices in Indonesian healthcare institutions and offers actionable recommendations for improving coding accuracy and claims processing.

Various factors influence pregnant women's knowledge of pregnancy danger signs, including age, education level, occupation, previous pregnancy experience, socioeconomic status, and access to health information. Insufficient knowledge of these signs, often due to limited access to health services and information, increases the risk of delays in managing pregnancy complications, which can negatively impact both maternal and fetal health. The purpose of this study was to explore the relationship between maternal characteristics, specifically age, and awareness of pregnancy danger signs. This quantitative study employed a correlational approach, using a questionnaire as the data collection tool. The study was conducted at the Tapa Health Center in Bone Bolango Regency, from April to August 2024, with 40 participants included. The Spearman statistical test was used to assess the relationship between maternal characteristics based on age and the knowledge of pregnancy danger signs before and after an intervention. The results showed a significant change in the knowledge levels of pregnant women, with the p-value of 0.852 indicating no direct relationship between maternal age and awareness of pregnancy danger signs. Although a positive change was observed in the knowledge levels after the intervention, the study concluded that there was no significant relationship between maternal age and knowledge of pregnancy danger signs. The findings suggest that while interventions can improve awareness, age alone does not appear to be a significant factor influencing knowledge levels. This highlights the importance of focusing on other factors such as education, health access, and targeted health interventions to enhance maternal awareness of pregnancy risks. Further studies with larger sample sizes and additional variables are recommended to provide a more comprehensive understanding of the factors that influence pregnancy-related knowledge.

Emesis gravidarum (EG) is a common condition experienced by pregnant women, characterized by nausea and vomiting that can negatively impact the health of both the mother and the fetus. Although often considered a normal part of pregnancy, EG can significantly impact a mother's quality of life. Age factors are thought to have an effect on the level of maternal knowledge about this condition, with older mothers tending to have a better understanding than younger mothers. This study used a quantitative design with a cross-sectional approach. A sample of 30 pregnant women in the first trimester was taken using the purposive sampling technique. Data were collected using questionnaires and analyzed using Pearson correlation tests. 60% of respondents were multigravida, and 40% of respondents (100%) were between the ages of 20 and 35. Seventy percent of people throw up more than three times a day. With an average score of 73.40 (on a scale of 50 to 90), Mother's level of knowledge showed variances in comprehension. The normality test revealed that the knowledge and age data were normally distributed. Since there was no discernible association between the mother's age and her degree of knowledge (r = 0.139, p = 0.465) according to the Pearson correlation test, other variables like education and information availability might be more important factors influencing knowledge. The age of the first-trimester pregnant women and their level of EG knowledge did not significantly correlate. Consequently, comprehensive health education is essential to enhance pregnant women's comprehension of EG, irrespective of age considerations.

Weight gain in contraceptive implant acceptors can have various negative health impacts, including degenerative diseases such as heart disease, hypertension, and a reduced ability to carry out daily activities. This study aimed to examine the relationship between the duration of contraceptive implant use and weight gain among women of reproductive age. A quantitative design with a cross-sectional approach was applied. The study population consisted of all contraceptive implant acceptors registered at the health facility, totaling 74 respondents. The sampling technique used was random sampling to ensure representativeness. The independent variable in this research was the duration of contraceptive implant use, while the dependent variable was weight change. Data were collected using a structured questionnaire, and statistical analysis was performed using the chi-square test. The results revealed a statistically significant relationship between the duration of contraceptive implant use and weight gain among respondents. Specifically, the longer the duration of implant use, the higher the likelihood of experiencing weight gain. This finding supports existing evidence that hormonal contraceptive implants may cause side effects, including increased body weight. If not properly managed, such weight gain can lead to overweight or obesity, conditions that substantially raise the risk of developing metabolic disorders such as diabetes mellitus, as well as cardiovascular diseases including hypertension and coronary heart disease. Based on these results, it is recommended that contraceptive implant users undergo regular weight monitoring to identify changes early. Additionally, health education programs emphasizing balanced nutrition and adequate physical activity should be implemented for women using hormonal contraceptives. Health care providers are encouraged to deliver comprehensive counseling prior to implant insertion, ensuring that potential side effects and preventive measures are clearly explained. Such proactive steps will help women make informed decisions and maintain optimal health while using contraceptive implants.

Indonesia's healthcare system continues to face significant challenges in delivering equitable services across diverse and remote regions. The digital transformation of healthcare—through the integration of Artificial Intelligence (AI), big data, and telemedicine—offers promising solutions to overcome disparities in access, infrastructure, and service delivery. This study aims to comprehensively analyze global and national research trends related to the digital transformation of healthcare using a Systematic Literature Review (SLR) approach, supported by bibliometric analysis through the VOSviewer software. Following the PRISMA protocol, a total of 30 relevant articles published between 2020 and 2025 were identified and analyzed. The network and overlay visualizations generated reveal four major thematic clusters: digital transformation and service quality, big data and pandemic response, AI and data privacy, and community engagement in digital health services. Overlay visualization also shows a clear shift in research focus—from early pandemic responses toward system optimization, ethical governance, and technological inclusivity in recent years. The findings highlight that digital healthcare transformation has increasingly evolved from emergency responses to COVID-19 into a strategic framework for long-term system improvement. Moreover, AI and big data have played pivotal roles in enhancing diagnostics, predicting outbreaks, and improving resource allocation. However, concerns related to privacy, digital literacy, and unequal technological access remain prominent. The study concludes that the integration of AI, big data, and telemedicine not only enhances healthcare efficiency but also requires strong regulatory frameworks, infrastructure readiness, and public engagement. Future research should incorporate co-citation and cross-country comparative analyses to enrich the understanding of digital health transformation in a global context, especially in low- and middle-income countries like Indonesia.

Indonesia's healthcare system continues to face significant challenges in delivering equitable services across diverse and remote regions. The digital transformation of healthcare—through the integration of Artificial Intelligence (AI), big data, and telemedicine—offers promising solutions to overcome disparities in access, infrastructure, and service delivery. This study aims to comprehensively analyze global and national research trends related to the digital transformation of healthcare using a Systematic Literature Review (SLR) approach, supported by bibliometric analysis through the VOSviewer software. Following the PRISMA protocol, a total of 30 relevant articles published between 2020 and 2025 were identified and analyzed. The network and overlay visualizations generated reveal four major thematic clusters: digital transformation and service quality, big data and pandemic response, AI and data privacy, and community engagement in digital health services. Overlay visualization also shows a clear shift in research focus—from early pandemic responses toward system optimization, ethical governance, and technological inclusivity in recent years. The study concludes that the integration of AI, big data, and telemedicine not only enhances healthcare efficiency but also requires strong regulatory frameworks, infrastructure readiness, and public engagement. Future research should incorporate co-citation and cross-country comparative analyses to enrich the understanding of digital health transformation in a global context.

Picky eating is a prevalent issue among preschool children, often leading to nutritional deficiencies, disrupted growth, and increased parental stress. This systematic literature review aims to explore the management of picky eating through complementary and alternative therapies (CAT) and compares these findings with contemporary interventions. Picky eating behaviors can significantly affect children’s eating patterns, leading to challenges in maintaining a balanced diet. Although traditional medical interventions focus on behavioral modification and nutritional counseling, many parents are seeking alternative approaches to manage these behaviors in a more holistic and natural manner. This review encompasses studies published between 2015 and 2025, sourced from PubMed, Scopus, and Google Scholar, using keywords such as "Alternative Therapy," "Picky Eating," and "Preschool Children." The review population consists of 20 articles, and the sample includes 5 selected studies that meet the criteria for evaluating the effectiveness of complementary and alternative therapies in managing picky eating behaviors. Data analysis utilized thematic analysis, with the findings analyzed thematically to draw conclusions regarding the efficacy of CAT. The results indicated that mindfulness practices, dietary practices, Tuina massage as a traditional therapy, taste exposure, sensory learning, and nutrition education were all effective in reducing picky eating behavior among children aged 1 to 5 years. These approaches not only helped to improve children’s acceptance of a wider variety of foods but also contributed to the reduction of stress for both children and parents. The findings suggest that integrating these alternative therapies into conventional practices can provide a comprehensive and effective strategy to address picky eating in preschool children. Future research is needed to further explore the long-term impacts of these therapies and to identify the most suitable combinations for different individual needs.

Anemia is a global health problem that often occurs in pregnant women. Inadequate pregnancy spacing can contribute to the risk of anemia. This study aims to analyze the relationship between pregnancy spacing and the incidence of anemia in pregnant women. This type of research is observational analytic with a case-control design. This study was conducted from February to October 2024 at a selected health center in the region. The case-control design was chosen to investigate the causes of anemia during pregnancy, particularly focusing on the effects of pregnancy spacing. The number of samples used was 30 cases, while 30 control cases were selected by simple random sampling from a larger pool of eligible pregnant women. The analysis employed the chi-square test to determine the statistical significance of the relationship between pregnancy spacing and the incidence of anemia. Results showed that 21.7% of respondents had anemia, with a significantly higher prevalence in those with a pregnancy spacing of less than two years. After conducting the chi-square test, the result yielded a significant p-value of 0.002, indicating a strong association between short pregnancy intervals and anemia. This finding highlights the potential risks associated with inadequate pregnancy spacing, emphasizing the importance of family planning and prenatal care in preventing anemia in expectant mothers. The study suggests that adequate pregnancy spacing may reduce the incidence of anemia, thus promoting healthier pregnancy outcomes. Furthermore, it underscores the need for educational programs aimed at raising awareness of the benefits of proper pregnancy planning. Such initiatives would not only help prevent anemia but also improve maternal and fetal health. Comprehensive health policies promoting spacing between pregnancies can have long-term positive effects on maternal well-being.

This study aims to analyze the accuracy of ICD-9-CM coding in Cathlab procedure claims submitted to BPJS Kesehatan under the INA-CBGs reimbursement system at RSI Aisyiyah Malang. Accurate coding is critical for determining appropriate claim grouping and tariff calculation within Indonesia’s national health insurance scheme. The research employed a mixed-methods approach, combining quantitative analysis of 244 Cathlab claims from 2024 with qualitative insights obtained through document review, interviews, and direct observation. The results showed that 182 claims (74.59%) were accepted as accurate and complete, while 62 claims (25.41%) were returned as pending. Common causes of claim inaccuracy included missing supporting documents (37.10%), incorrect ICD-9-CM codes (27.42%), and nonspecific diagnoses (19.35%). Procedural miscoding, such as omitting dual catheterization codes or stent-related procedure codes, was identified as a frequent issue, significantly impacting claim grouping and reimbursement. The study highlights systemic challenges related to documentation quality, coder competency, and institutional claim verification processes. These challenges result in delays, incorrect payments, and administrative inefficiencies, posing barriers to effective reimbursement. The findings underscore the importance of implementing Clinical Documentation Improvement (CDI) strategies, improving coder training, and transitioning to newer coding systems such as ICD-10 or ICD-11. Upgrading to these systems will support better coding accuracy, enhance claim processing efficiency, and ensure more appropriate reimbursement. Strengthening these components is essential to ensure the integrity of Indonesia’s health financing system, improve operational workflows, and ensure that healthcare providers receive timely and accurate reimbursement for services rendered. This study provides a comprehensive evaluation of the current state of coding practices in Indonesian healthcare institutions and offers actionable recommendations for improving coding accuracy and claims processing.

Various factors influence pregnant women's knowledge of pregnancy danger signs, including age, education level, occupation, previous pregnancy experience, socioeconomic status, and access to health information. Insufficient knowledge of these signs, often due to limited access to health services and information, increases the risk of delays in managing pregnancy complications, which can negatively impact both maternal and fetal health. The purpose of this study was to explore the relationship between maternal characteristics, specifically age, and awareness of pregnancy danger signs. This quantitative study employed a correlational approach, using a questionnaire as the data collection tool. The study was conducted at the Tapa Health Center in Bone Bolango Regency, from April to August 2024, with 40 participants included. The Spearman statistical test was used to assess the relationship between maternal characteristics based on age and the knowledge of pregnancy danger signs before and after an intervention. The results showed a significant change in the knowledge levels of pregnant women, with the p-value of 0.852 indicating no direct relationship between maternal age and awareness of pregnancy danger signs. Although a positive change was observed in the knowledge levels after the intervention, the study concluded that there was no significant relationship between maternal age and knowledge of pregnancy danger signs. The findings suggest that while interventions can improve awareness, age alone does not appear to be a significant factor influencing knowledge levels. This highlights the importance of focusing on other factors such as education, health access, and targeted health interventions to enhance maternal awareness of pregnancy risks. Further studies with larger sample sizes and additional variables are recommended to provide a more comprehensive understanding of the factors that influence pregnancy-related knowledge.

Emesis gravidarum (EG) is a common condition experienced by pregnant women, characterized by nausea and vomiting that can negatively impact the health of both the mother and the fetus. Although often considered a normal part of pregnancy, EG can significantly impact a mother's quality of life. Age factors are thought to have an effect on the level of maternal knowledge about this condition, with older mothers tending to have a better understanding than younger mothers. This study used a quantitative design with a cross-sectional approach. A sample of 30 pregnant women in the first trimester was taken using the purposive sampling technique. Data were collected using questionnaires and analyzed using Pearson correlation tests. 60% of respondents were multigravida, and 40% of respondents (100%) were between the ages of 20 and 35. Seventy percent of people throw up more than three times a day. With an average score of 73.40 (on a scale of 50 to 90), Mother's level of knowledge showed variances in comprehension. The normality test revealed that the knowledge and age data were normally distributed. Since there was no discernible association between the mother's age and her degree of knowledge (r = 0.139, p = 0.465) according to the Pearson correlation test, other variables like education and information availability might be more important factors influencing knowledge. The age of the first-trimester pregnant women and their level of EG knowledge did not significantly correlate. Consequently, comprehensive health education is essential to enhance pregnant women's comprehension of EG, irrespective of age considerations.

The learning system in the majority of Polytechnics uses Blended Learning systems including face to face, practice / workshop and online with learning composition; 40% theory and 60% practice with industry link and match mechanisms. For industry link and match, a comprehensive policy between ministries is needed to determine the functional position of the Learning Technology Developer (PTP) as an integrated manager of the learning program in tertiary institutions especially the Polytechnic both various learning resources, methods, teaching materials, media and learning environments so that learning outcomes can increase the production of goods and services quickly, effectively and efficiently through meaningful, enjoyable learning. The method used in this research is "descriptive quantitative" because it describes, describes, and interprets the conditions, events, processes that are happening in the context of the problem. This research is intended to explore and clarify a phenomenon or social reality clearly. Online and conventional system learning methods or blended learning enable HR outcomes that are able to overcome technological disruption, on the other hand the hopes of the President and Menristekdikti that the ability to deal with the industrial revolution 4.0 in the era of technological disruption and globalization competition is not only through special abilities obtained because of completing master's education, master's degree in tertiary education which is said to produce responsive ability of industry 4.0 involvement but through improvement of learning culture. Indicator 0.033% of HR career as Developers of Learning Technology in tertiary institutions shows low regard for tertiary institutions in developing learning programs in the development of learning programs both the management of various learning resources, methods, media, teaching materials and learning environments according to the need for meaningful and enjoyable learning, this is caused by professional ego, sectoral ego.    

The learning system in the majority of Polytechnics uses Blended Learning systems including face to face, practice / workshop and online with learning composition; 40% theory and 60% practice with industry link and match mechanisms. For industry link and match, a comprehensive policy between ministries is needed to determine the functional position of the Learning Technology Developer (PTP) as an integrated manager of the learning program in tertiary institutions especially the Polytechnic both various learning resources, methods, teaching materials, media and learning environments so that learning outcomes can increase the production of goods and services quickly, effectively and efficiently through meaningful, enjoyable learning. The method used in this research is "descriptive quantitative" because it describes, describes, and interprets the conditions, events, processes that are happening in the context of the problem. This research is intended to explore and clarify a phenomenon or social reality clearly. Online and conventional system learning methods or blended learning enable HR outcomes that are able to overcome technological disruption, on the other hand the hopes of the President and Menristekdikti that the ability to deal with the industrial revolution 4.0 in the era of technological disruption and globalization competition is not only through special abilities obtained because of completing master's education, master's degree in tertiary education which is said to produce responsive ability of industry 4.0 involvement but through improvement of learning culture. Indicator 0.033% of HR career as Developers of Learning Technology in tertiary institutions shows low regard for tertiary institutions in developing learning programs in the development of learning programs both the management of various learning resources, methods, media, teaching materials and learning environments according to the need for meaningful and enjoyable learning, this is caused by professional ego, sectoral ego.