Meaningful Assessment or Minimum Compliance: PASRR for Nursing Home Residents with Mental Illness

The Omnibus Budget Reconciliation Act (OBRA) of 1987 included provisions for the Preadmission Screening and Resident Review (PASRR) program, which requires states to create and maintain systems to assess persons with serious mental illness (SMI) seeking NH care. The prevalence of SMI in NHs is increasing, and little is known about the effectiveness of the PASRR program intervention. We conducted 20 interviews with state and national PASRR stakeholders, including assessors, hospital discharge planners, mental health advocates, geriatricians and geriatric psychiatrists. Interview data were triangulated with state provided materials on PASRR collection and implementation. Based on these interviews, we identified four themes: 1) variation in the implementation of federal PASRR legislation across states and jurisdictions, 2) the need for investment in professional development and workforce capacity, 3) lack of usefulness of PASRR in ongoing care planning, and 4) the need to consider the role of age, race/ethnicity, and stigma on quality of care for NH residents with SMI. Stakeholders agree that PASRR legislation was well intentioned, but also expressed concern regarding the completion of PASRR as an issue of compliance versus meaningful assessment. More work is needed to determine how best to develop and support the care needs of people with SMI, while being mindful of the original goals of deinstitutionalization that prompted OBRA passage. In order to assess the impact of the PASRR program on quality of care and mental health outcomes, further research should take an evaluative approach through meaningful use of PASRR data.

The Effectiveness of Pay-for-Performance Program of Diabetes Care for Psychiatric Patients: A Regional Psychiatric Hospital Experience

Background: The Pay-for-performance (P4P) program of diabetes care has demonstrated successful outcomes in patients with type 2 diabetes. However, the effectiveness of this multidisciplinary care model for psychiatric patients has never been evaluated. The objective of this study is to examine the effectiveness of P4P program of diabetes for psychiatric patients with diabetes. Methods: This study utilized a retrospective cohort design to examine the effectiveness of P4P program of diabetes care for psychiatric patients with diabetes. The participants’ HbA1c (hemoglobin A1c) data of the fourth quarter in 2018 were used as baseline value, while P4P program was not applied yet. HbA1c data of every quarter in 2019 were collected. Generalized estimating equations (GEE) was used to analyze the change of HbA1c level. Results: The HbA1c level increased slightly in the first quarter, and then decreased gradually since the second quarter. The HbA1c level was significantly lower in the fourth quarter after P4P program intervention (p < 0.05). Conclusion: P4P program of diabetes care is also effective on psychiatric patients with diabetes, and this multidisciplinary care model could be encouraged and promoted for psychiatric patients with diabetes.

The measurement of food and nutrition security situation in Indonesia

An appropriate analysis of the food security situation influences the decision-making and even planning of targeted intervention. Considering Indonesia’s vast area and different characteristics of each region, information on the food security situation for each region is needed for policy intervention. This paper conducted a composite analysis to obtain the food security situation of 416 districts in Indonesia. The weighting approach of nine indicators represented the three subsystems of food security, namely food availability, food access, and food utilization, was used for food security situation analysis. Of 416 districts, 81 were classified into food vulnerable region-based one a set of cut-off points used for districts classification. These vulnerable food regions were mainly characterized by the ratio between food production and normative consumption, the percentage of people living under the poverty line, and the prevalence of stunting. The information on vulnerable food regions and their underlying factors can be used as a basis for program intervention and policy formulation for food security in Indonesia. The program designed for food vulnerability alleviation should be located in the vulnerable food area and targeted to reduce those three underlying factors causing food vulnerability.

Multimodal physical exercise and functional rehabilitation program in oncological patients with asthenia. study protocol

Background The increase in the survival of oncology patients include multiple side effects as cancer-related asthenia and dyspnea, which represents a serious health problem. An implementation of the conventional clinical practice, developed through multimodal physical exercise and functional rehabilitation program intervention, may be useful in controlling dyspnoea. This study aims to evaluate the effects of a multimodal exercise and functional rehabilitation program on fatigue, pain, functional capacity, and quality of life in cancer patients with cancer-related asthenia. Methods This is a protocol for an experimental, prospective, randomised study using a parallel, fixed assignment scheme, with an experimental group and a control group in patients from the oncology hospitalisation unit at the Salamanca University Hospital Complex in Spain, using consecutive sampling to select 50 participants with oncological asthenia who are hospitalised at the time of inclusion. After the baseline evaluation, the participants will be randomised into two groups. Both groups will receive standard clinical practice care and the normal health education program at discharge, but in addition, the participants assigned to the experimental group will also complete a multimodal exercise and functional rehabilitation program lasting one month. The primary outcomes will be basic activities of daily living (Barthel Index) and degree of asthenia (FACT-An scale). Additionally, physical performance will be evaluated with the Short Physical Performance Battery (SPPB), as will the attention and executive functions (Trail-Making Test), fear/avoidance of movement (TAMPA scale), pain (VAS scale), and body composition (waist, hip, brachial, thigh, wrist, and ankle circumferences). Discussion The results of this study may be translated to clinical practice, incorporating a specific autonomy recovery programme into comprehensive rehabilitation programmes of care for cancer patients with asthenia. The current study addresses to improve the conventional clinical practice by proposing a multimodal physical exercise and functional rehabilitation program intervention, which will be implemented by an interdisciplinary team, to try to improve the autonomy of cancer patients with cancer-related asthenia. Trial registration ClinicalTrials.gov; ID: NCT04761289. (February 18, 2021). https://clinicaltrials.gov/ct2/show/ NCT04761289.

Penyuluhan Kesehatan Konsumsi Buah dan Sayur di Rw 003 Kelurahan Benda Baru Pamulang Sebagai Upaya Pencegahan Tuberkolosis

Di Indonesia pemberantasan penyakit tuberkulosis telah dimulai sejak tahun 1950 dan sesuai rekomendasi WHO sejak tahun 1986 regimen pengobatan yang semula 12 bulan diganti dengan pengobatan selama 6-9 bulan. Pemerintah sudah sangat serius memperhatikan masalah TBC, dengan memberikan bantuan berupa pemberian obat TBC secara gratis. Namun faktanya, efektifitas pengobatan yang dilakukan oleh penderita TBC masih rendah. Tingkat kesembuhan penderita tuberkulosis adalah sebesar 85,30%, dengan tingkat kesukaan buah sebanyak 84%. Namun intensitas responden dalam mengkonsumsi buah hanya sebesar 68% dan tingkat konsumsi buah hanya sebesar 65,30%, serta tingkat keteraturan konsumsi buah saat menderita tuberkulosis hanya sebesar 67,30%. Berdasarkan hasil Musyawarah Masyarakat Desa, masyarakat sepakat untuk memilih TBC untuk menjadi acuan intervensi program. Pengabdian Masyarakat yang dilakukan dalam bentuk penyuluhan ini mengangkat tema “Ayo Konsumsi Buah dan Sayur untuk Putus Tali Penularan TBC.” Penyuluhan kesehatan ini dilaksanakan pada hari Sabtu, 15 Februari 2020 di Mushola AR-Rahman RT 04 RW 003. Dihadiri oleh 30 orang terdiri dari lapisan masyarakat dari RW 003 Kelurahan Benda Baru. Berdasarkan hasil perhitungan pre-test dan post-test, didapatkan bahwa ada peningkatan pengetahuan masyarakat terkait manfaat buah dan sayur untuk penyakit Tuberkolosis antara sebelum dan setelah diberikan penyuluhan. Disarankan agar kebiasaan maka buah dan sayur bisa menjadi kebiasaan di tengan masyarakat.---In Indonesia the eradication of tuberculosis has been started since 1950 and according to WHO recommendations since 1986 the treatment regimen that was originally 12 months replaced with treatment for 6-9 months. The government has been very serious about paying attention to the TBC problem, by providing assistance in the form of giving free TBC medicines. But in fact, the effectiveness of treatment carried out by people with TBC is still low. It was found that the cure rate of tuberculosis patients was 85.30%, with a fruit preference rate of 84%. But the intensity of respondents in consuming fruit was only 68% and the level of fruit consumption was only 65.30%, and the level of regularity of fruit consumption when suffering from tuberculosis was only 67.30%. Based on the results of the Village Community Conference, the community agreed to choose TBC as a reference for program intervention. Community Service is carried out in the form of counseling with the theme "Let's Eat Fruits and Vegetables to Break the Rope of TBC Transmission." This health education was held on Saturday, February 15, 2020 at Mushola AR-Rahman RT 04 RW 003. Attended by 30 people consisting of people from RW 003 Benda Baru Village. Based on the results of the pre-test and post-test calculations, it was found that there was an increase in community knowledge related to the benefits of fruits and vegetables for tuberculosis between before and after counseling. It is suggested that the habbit of fruit and vagetables can become a habit among the people.

Pengembangan Organisasi Menggunakan Open System Model

Pt. PN is a company engaged in coal mining contractors. One of the vision &mission of PT. PN is becoming a global top 8 company that has excellence in all fields. Business expansion is one of the company's agenda to become an excellent mining company in Indonesia. This research was conducted to identify and map problems in PT PN by using open system model diagnostic method and data collection with qualitative method. The results showed that there are problems in the HRM system, not optimal HRM system because the development program has not been optimal, so it has an impact on employee competence, competency problems then impact on employee readiness on the business expansion agenda. Mentoring program intervention at the deputy project manager level aims to assist the company in carrying out the development process in the company. The intervention of this mentoring program also supports the company's mission in improving the quality of human resources and preparing competent cadres for organizational sustainability.

Analysis of Head Impact Biomechanics in Youth Female Soccer Players Following the Get aHEAD Safely in Soccer™ Heading Intervention

The effects of repetitive head impacts associated with soccer heading, especially in the youth population, are unknown. The purpose of this study was to examine balance, neurocognitive function, and head impact biomechanics after an acute bout of heading before and after the Get aHEAD Safely in Soccer™ program intervention. Twelve youth female soccer players wore a Triax SIM-G head impact sensor during two bouts of heading, using a lightweight soccer ball, one before and one after completion of the Get aHEAD Safely in Soccer™ program intervention. Participants completed balance (BESS and SWAY) and neurocognitive function (ImPACT) tests at baseline and after each bout of heading. There were no significant changes in head impact biomechanics, BESS, or ImPACT scores pre- to post-season. Deficits in three of the five SWAY positions were observed from baseline to post-season. Although we expected to see beneficial changes in head impact biomechanics following the intervention, the coaches and researchers observed an improvement in heading technique/form. Lightweight soccer balls would be a beneficial addition to header drills during training as they are safe and help build confidence in youth soccer players.

School Readiness of Supplemental Fed Preschoolers in Maguindanao

Please Pass the Bread” (PPtB) feeding program is an international program that aims to reduce the number of malnurished children in the province of Maguindanao. Thus, this study sought to determine the School Readiness of Supplementally Fed Preschoolers in Maguindanao. Specifically, the study determined the significant improvement of the preschoolers’ scores after the intervention (“Please Pass the Bread” (PPtB) feeding program). The pretest-posttest design of research was used, with the School Readiness Year-end Assessment Checklist (SReYA). The Checklist was the main tool for data gathering. The mean and percentage counts were used to describe the pretest and posttest score of the preschoolers. The t-test was used to determine the significant difference between the pupils’ pretest and posttest scores. The t-value was set at 0.05 levels of significance. Findings show that there is a significant difference in gain between the control and experiment group. This implies that the scores of the pupils improved significant after the exposure to the Please Pass the Bread” (PPtB) feeding program intervention. This mean that “Please Pass the Bread” (PPtB) feeding program intervention really helped improved the pupils’ school readiness.Thus, it is concluded that the “Please Pass the Bread” (PPtB) feeding program intervention significantly improves the readiness of the preschooler children in Maguindanao.

Pengaruh program multi-exercise terhadap fungsi kognitif pada lansia overweight dan tidak overweight

The effect of the multi-exercise program on cognitive function in overweight and non-overweight elderlyBackground: Cognitive function is the factor that determines the disability of the elderly to live a healthy and independent life. The results of studies regarding the protective effect or detrimental effects of overweight or obesity on cognitive function in the elderly are still controversial. Objective: This study aims to determine the effect of the multi-exercise program on cognitive function in the elderly based on nutritional status.Methods: This quasi-experimental study with a pretest-postest design study involved 37 elderly aged 60-74 years. Body mass index (BMI) derived from the measurement of body weight and height were grouped into overweight and not-overweight. Both groups received a multi-exercise in the form of gymnastic exercise (30 minutes), square stepping exercise (30 minutes), and puzzle games (30 minutes). The intervention was given 12 times with a frequency of 3 times per week. Cognitive function was measured by using the Mini-Mental State Examination (MMSE) questionnaire. Data analysis used paired sample t-test and independent t-test. Results: The multi-exercise program intervention given affected improving cognitive function in the overweight elderly group (p=0.003). However, it is different from the non-overweight elderly group who did not show a significant effect of the multi-exercise program on the cognitive function (p=0.184) even though there was an increase in the mean cognitive function at the end of the intervention. Conclusions: Multi-exercise program intervention for 4 weeks with a frequency of three times per week can improve the cognitive function of the elderly, but statistically only significant in the overweight elderly group.

Randomized Trial for Weight Loss Using a Digital Therapeutic Application

Background: Smartphones present a near-ubiquitous channel through which structured lifestyle change can reduce risk or progression of the most common noncommunicable diseases. We explored whether a digital structured lifestyle program enhances weight loss. Methods: We randomized overweight and obese participants attending a four-month lifestyle change program to either standard weekly coaching sessions (controls), or standard treatment supplemented with a digital therapeutic mobile application (intervention). Changes in body mass index after four months were the main outcome measure. Odds ratios of achieving 5% weight loss were estimated with unconditional logistic regression. Results: Of 234 eligible persons, 146 (62%) agreed to participate, were block-randomized, showed up for the baseline measures, and constituted the intention-to-treat (ITT) sample ( n = 95 intervention group, n = 51 control group). In the intervention group, 70 (74%) downloaded the mobile application and completed the program (intervention per-protocol). Significant weight loss and BMI reduction were observed for both the intention-to-treat intervention group ( P < 0.05, P = 0.01) and the per-protocol intervention group ( P < 0.0001, P < 0.0001). For the intervention per-protocol group, the odds ratio of achieving 5% weight loss, compared to not treated per-protocol, was 3.3 (95% CI 1.3-8.2), adjusting for age and weight at baseline.Attendance to weekly coaching sessions decreased by 18% during the program in the control group while it increased by 3% amongst the per-protocol group ( P = 0.004). Conclusions: These preliminary findings support the benefit of a digital therapeutic to enhance weight reduction and attendance in a structured lifestyle change program. Larger trials of longer duration are needed to confirm these findings.