Supplemental Program Research Articles

Natal Contributions of Kokanee Salmon to Flaming Gorge Reservoir, Wyoming–Utah: An Evaluation Using Otolith Microchemistry

Abstract In a system that uses supplemental stocking to enhance a fishery that serves a dual purpose, an understanding of the contributions from natural and hatchery-produced fish is important so that hatchery resources can be appropriately allocated. Kokanee Oncorhynchus nerka were first stocked in Flaming Gorge Reservoir (FGR), Wyoming–Utah, in 1963 and serve a dual purpose as a prey resource and sport fish. Although natural recruitment occurs in the reservoir, a supplemental stocking program was initiated in 1991. We sought to identify the natal origin (i.e., natural, hatchery) of kokanee in FGR using otolith microchemistry. We evaluated return to the creel, composition of spawning aggregates, and growth of kokanee in FGR and focused on differences associated with natal origin. We analyzed kokanee otoliths that we collected from hatcheries (n = 60) and FGR (n = 1,003) for the strontium isotope ratio, 87Sr/86Sr, using laser ablation and a multicollector inductively coupled plasma mass spectrometer. We conducted Kruskal–Wallis tests to compare the strontium isotope ratios from the otolith edge of kokanee that we sampled from hatcheries and FGR. Based on 87Sr/86Sr ratios, we could distinguish natural-origin kokanee from 11 of the 12 hatcheries (P < 0.01); however, the Wigwam Hatchery was not significantly different from FGR (P = 0.84). We used model-based discriminant function analysis to assign natal origins for kokanee caught in FGR. Hatchery contribution to the population at large varied from 21 to 50% among year classes from 2014 to 2018. The percentage of hatchery origin kokanee in the creel (18–50%) was similar to what we observed in the population. Hatchery-produced kokanee contributed a higher proportion to tributary-spawning aggregates (40–90%) than shoreline-spawning aggregates (19–58%) by sample year. Growth of natural and hatchery kokanee was similar, suggesting similar performance in the system. Results from this study identify that hatchery supplementation contributes to the population and recreational harvest of kokanee in FGR. This research also provides insight into the ecology of kokanee that is useful for better understanding kokanee population dynamics in reservoir systems.

PANGAN LOKAL (GRANOLA MORINGA) SEBAGAI MAKANAN TAMBAHAN PENCEGAH STUNTING PADA BALITA GIZI KURANG DI PUSKESMAS DOMPU BARAT KABUPATEN DOMPU

UNICEF explained that if nutrition problems are not taken care of properly during the Covid-19 pandemic, there will be a 15% increase in the number of children <5 years old who experience acute malnutrition can increase the risk of stunting. The stunting data in NTB (2020) is 20.9%, where the highest stunting data is in West Lombok Regency (29.3%), and the lowest is in Bima City (7.9%). Dompu Regency ranks 5th at 25%, whereas Woja District is the area with the highest stunting incidence in 2020 is 54.98%. Based on e-PPGBM data (2020) in Woja District, there are 3rd villages with the highest stunting rate, namely Matua Village 82.04%, Monta Baru Village 61.9%, and Rababaka Village 60.71%. This study aims to analyze the nutritional benefits of supplementary feeding with granola moringa in undernourished children; measure and analyze changes in the nutritional status and development of children; prepare recommendations for the sustainability of the granola moringa supplementary food program with the Dompu Barat Health Center. The research method uses quantitative methods with a quasi-experimental approach with a control group. The data collection instruments were interview guides and observation sheets. Data analysis used the sample paired t-test. The results of the test of paired sample t-test obtained a sig value. (2-tailed) is 0.001 < 0.05 with t value -10.456 > t table 2 means that there is a difference in the average weight of children after being given granola moringa, which means that there is an effect of local food (granola moringa) as additional food for stunting prevention in malnutrition toddlers and the effectiveness of giving granola moringa was 0.4 (medium category).

ZERO HUNGER Vs MALNUTRITION: DOUBLE EDGED SWORDGROUND REALITY BASED ON NATIONAL FAMILY HEALTH SURVEY-V, INDIA

Background: Recently released Global Hunger Index has put India’s effort in the field of nutrition in a conundrum. Despite significant steps taken to improve nutrition, India is grappling with double edged sword of Malnutrition. Malnutrition, under or over, has affected many countries across the globe. Objective: This article explores the ground reality in the meadow of Nutrition status revealed by National Family Health Survey (NFHS)-5 data for 36states/UTs in India. Material and Methods: It explicitly evaluates the success and inadequacies based on parameters and comparing them with NFHS-4 data. The paper takes on the panoramic view of all forms of malnutrition in different sections as well as the various initiatives and existing programs addressing this issue. Findings: Among the 22 states, 16 states recorded an increase in underweight and severely wasted fewer than 5 children, which were surveyed during the first phase of the NFHS -5. The NFHS-5 data again revealed that except for Goa & Diu all the states / UTs have shown an increase in the percentage of overweight children over the past 5 years. Conclusion: We need timely nutritional interventions, full immunization, and supplementation programs. PoshanAbhiyan components should be implemented using Inter sectoral convergence and use of technology (ICT) for better service delivery.

National Vitamin A Supplementation Program in primary care: what is the reality in Minas Gerais, Brazil?

The present study aimed to evaluate the National Vitamin A Supplementation Program in Minas Gerais, adopting the mixed sequential explanatory method. The quantitative approach adopted the multidimensional instrument per the components of vitamin A supplementation and food and nutrition education. We employed an analysis matrix with parameters to define the implementation as adequate, partially adequate, inadequate, and critical. We used semi-structured interviews in the qualitative approach. The "process" dimension was better evaluated than the "structure", with an implementation level (IL) of 84.6% and 78.5%, respectively. The Program's strengths include supplementation planning, achieving goals, recording information, supporting breastfeeding, and the performance of Community Health Workers. Weaknesses are fragmented work, analysis of information limits, access to the Program's actions, implementation of educational actions, and lack of or insufficient availability of nutritionists and training. The Program's reality only partially considered health promotion actions and focused on vitamin A supplementation. Implementing food and nutritional education actions is imperative to face vitamin A deficiency.

The role of social support and interpersonal trust to improve compliance of iron supplementation amongst adolescent girls: A qualitative approach.

Adolescence is a crucial phase in preventing and controlling anaemia. One of the efforts made by the Indonesian government to overcome adolescent girl's anaemia is the iron and folic acid (IFA) supplementation programme. This programme is one of the most effective interventions that various countries have used to overcome anaemia. The key to the success of the supplementation of IFA is the compliance of adolescent girls. This study investigates the compliance and its contributing factors of IFA supplementation and the role of social support and interpersonal trust as a source of information and reminder amongst adolescent girls in Sidoarjo, Indonesia. This research was a qualitative study using the in-depth interview to collect data. Thirteen adolescent girls from three high schools in Sidoarjo, Indonesia, were recruited using a snowball sampling technique. Most of the girls did not comply with IFA supplementation. Contributing factors were the influence of peers, influence of teachers, parental influence, risk and benefit of taking IFA tablet and also failure to remember to take IFA tablet. The social environment that provided information and reminder came from teacher, parent, peer and also health worker. Interpersonal trust was needed to have positive perceived social support. Compliance with the consumption of IFA supplements requires the cooperation of various parties (teachers, parents, peers and health workers) and also interpersonal trust between adolescent girls to their social environment so the programme could be run optimally.

Programa Nacional de Suplementação de Vitamina A na atenção primária: qual a realidade em Minas Gerais, Brasil?

Abstract The present study aimed to evaluate the National Vitamin A Supplementation Program in Minas Gerais, adopting the mixed sequential explanatory method. The quantitative approach adopted the multidimensional instrument per the components of vitamin A supplementation and food and nutrition education. We employed an analysis matrix with parameters to define the implementation as adequate, partially adequate, inadequate, and critical. We used semi-structured interviews in the qualitative approach. The “process” dimension was better evaluated than the “structure”, with an implementation level (IL) of 84.6% and 78.5%, respectively. The Program’s strengths include supplementation planning, achieving goals, recording information, supporting breastfeeding, and the performance of Community Health Workers. Weaknesses are fragmented work, analysis of information limits, access to the Program’s actions, implementation of educational actions, and lack of or insufficient availability of nutritionists and training. The Program’s reality only partially considered health promotion actions and focused on vitamin A supplementation. Implementing food and nutritional education actions is imperative to face vitamin A deficiency.

EngAge – A metacognitive intervention to supplement working memory training: A feasibility study in older adults

Working Memory (WM) training has shown promise in supporting cognitive functioning in older adult populations, but effects that generalize beyond the trained task have been inconsistent. Targeting cognitive processes in isolation might be a limiting factor given that metacognitive and motivational factors have been shown to impact older adults’ engagement with challenging cognitive activities, such as WM training. The current feasibility study implemented a novel metacognitive intervention in conjunction with WM training in older adults and examined its potential amplifying short- and long-term effects on cognitive and self-report outcomes as compared to WM or active control training alone. One-hundred and nineteen older adults completed acognitive training over the course of 20 sessions at home. The cognitive training targeted either WM or general knowledge. In addition, one of the WM training groups completed a metacognitive program via group seminars. We tested for group differences in WM, inhibitory control, and episodic memory, andwe assessed participants’ perceived self-efficacy and everyday memory failures. At post-test, we replicated earlier work by demonstrating that participants who completed the WM intervention outperformed the active control group in non-trained WM measures, and to some extent, in inhibitory control. However, we found no evidence that the supplemental metacognitive program led to benefits over and above the WM intervention. Nonetheless, we conclude that our metacognitive program is a step in the right directiongiven the tentative long-term effects and participants’ positive feedback, but more longitudinal data with larger sample sizes are needed to confirm these early findings.

Using a design-based research approach for a supplementary instruction programme: A pedagogical intervention during the COVID-19 pandemic

Using a design-based research approach for a supplementary instruction programme: A pedagogical intervention during the COVID-19 pandemic

Characterization of micronutrient supplements use by Brazilian children 6-59 months of age: Brazilian National Survey on Child Nutrition (ENANI-2019).

This study aimed to characterize micronutrient supplements use among Brazilian children 6-59 months of age included in the Brazilian National Survey on Child Nutrition (ENANI-2019; n = 12,598). Micronutrient supplements use at the time of the interview and the 6 months prior to it was evaluated using a structured questionnaire. The following indicators were included: micronutrient supplement use; supplements containing a single micronutrient; supplements of the Brazilian National Iron Supplementation Program (PNSF); multivitamin supplements with or without minerals; multivitamin supplements with minerals; multivitamin supplements without minerals. The estimates and their respective 95% confidence intervals (95%CI) were calculated for Brazil and according to macroregion, educational level of the mother or caregiver, and type of health care service used, considering the sampling plan, weights, and calibration. In Brazil, the prevalence of micronutrient supplements use was 54.2% (95%CI: 50.5; 57.8), with the highest prevalence in the North Region (80.2%; 95%CI: 74.9; 85.6) and among children 6-23 months of age (69.5%; 95%CI: 65.7; 73.3). The prevalence of the use of supplements containing exclusively iron and exclusively vitamin A in Brazil was 14.6% (95%CI: 13.1; 16.1) and 23.3% (95%CI: 19.4; 27.1), respectively. The prevalence of the use of multivitamin with or without minerals in Brazilian children 6-59 months of age was 24.3% (95%CI: 21.4; 27.2). These results may help to understand the practice of supplements use among Brazilian children and support the proposal of national public policies for the prevention and control of micronutrient deficiencies.

Prevalence and Trends of Birth Defects - Five Counties, Shanxi Province, China, 2003-2022.

The Shanxi Province, located in northern China, holds the highest prevalence of birth defects (BDs) across the country. Following the implementation of a nationwide folic acid supplementation program in 2009, a significant reduction of 53.89% in the prevalence of neural tube defects (NTDs) was observed in Shanxi from 2012 to 2017. However, despite this decrease, the prevalence rate for congenital heart defects (CHDs) in 2017 was over four times that of the 2012 rate. Since 2014, CHDs have emerged as the most predominant BD in Shanxi. The present study has identified a marked reduction in the prevalence of both total BDs and NTDs in five counties within Shanxi over the past two decades. As of 2017-2022, NTDs continue to be the most prevalent BDs recorded in this region. Contrarily, there has been a noteworthy increase in the prevalence of CHDs, ranking them among the top five most common BDs in the region between 2017 and 2022, though their rate remains below the national average. Additionally, the proportion of external anomalies remains high. Nevertheless, due to constrained access to primary healthcare services and diagnostic facilities, the early detection rate for internal anomalies, particularly CHDs, may be underestimated in the region. The results of this study underscore the necessity for augmented efforts in promoting folic acid supplementation as a preventive measure for NTDs. Moreover, improvements in the distribution of medical resources within this region are recommended, particularly the introduction and enforcement of local training programs aimed at enhancing CHD screening and diagnostic processes in these respective counties.

A Survey of Chinese Regular Blood Donors who were Enrolled into an Iron Replenishment Program – a Hint for Dietary Factors

Background and Objectives: Concern on donors' health and safety is growing in importance in many countries. One of the key issues is related to low body iron store in regular blood donors that some countries have advocated iron supplementation in addition to education. A survey was performed to look at the dietary factors in blood donors under an iron replenishment program in Hong Kong. The objectives of this survey were to evaluate the possible causes for iron deficiency and evaluate the effectiveness of education and iron supplementation program. Methods: A pre- and post- health education survey was conducted to evaluate the effectiveness of an iron replenishment program addressing iron deficiency among regular blood donors. Eligible donors were invited to attend a health education held by a registered nurse after predonation hemoglobin test. A questionnaire was used to ask donors on their dietary habit, knowledge on iron deficiency, and iron supplement. Results: Of 428 participants, male donors preferred eating out for breakfast (P = 0.003) and lunch (P = 0.0005) than females. Those donors who preferred eating out were also likely to have higher frequency of taking tea or coffee (P = 0.0005). When compared the donors' knowledge and confident level in taking iron replacement, significance was identified between genders and pre- and posthealth education. An affirmative donor satisfaction toward the nursing support and the iron replenishment program was also observed. Conclusion: The study result provided an insight into the possible dietary factors. The positive outcome of the health education warrants further planning of educational strategies to address the gender difference but also to achieve a better effect from iron replenishment.

Uso de suplemento de ferro para prevenção da anemia em crianças de seis a 59 meses atendidas pela Estratégia Saúde da Família de um município de Minas Gerais, Brasil

Abstract Objectives: to evaluate the use of iron supplementation and associated factors in children aged six to 59 months attended at the Family Health Strategy units in a city in Minas Gerais (MG). Methods: a cross-sectional, analytical-exploratory study, carried out with 252 children aged six to 59 months, attended at ten units, between 2014 and 2016. A structured questionnaire was used to collect data on socioeconomic conditions, maternal health, child’s health and the knowledge of those responsible regarding anemia and iron supplementation, in addition to analysis of the child’s medical records /booklet to collect test results. Descriptive statistics, bivariate association analysis and logistic regression for multivariate analysis were performed. Results: only 22.6% of the children aged between six and 24 months were receiving iron supplement at the time of the interview. Considering children aged six to 59 months, 13.1% were supplemented and breastfeeding time (p=0.006) and the participation in childcare (p=0.042), were positively associated with the use of supplementation. Conclusion: most children aged six to 24 months were not receiving supplementation as recommended by the Ministry of Health, demonstrating the need to implement prevention programs, such as the National Iron Supplementation Program and training of professionals on the importance of health education in preventing childhood anemia.

PREP Plus combined postrehabilitation programme to support upper limb recovery in community-dwelling stroke survivors: protocol for a mixed-methods, cluster-assigned feasibility study

IntroductionPoor recovery of the upper limb following a stroke has been recognised as a significant problem in the UK. Although there is good evidence that early, intense rehabilitation can lead...

Faktor Pemungkin dan Penguat Perilaku Ibu Membawa Anaknya ke Pos Pelayanan Terpadu (Posyandu)

The integrated service post program (in Indonesian: posyandu) aims to reduce infant mortality, and maternal mortality rates. However, the coverage of posyandu visits in Singosari sub-district was low (<50%) in 2021; hence this study aims to identify enabling and reinforcing factors of the behavior of posyandu visits. This research was conducted in Banjarum Village on 61 mothers who have toddlers. The survey instrument was used to identify factors related to the behaviour of visiting the posyandu under five. The results of the enabling factors showed that 88.52% of mothers had a health card, 93.44% of mothers said their children did not receive immunisation at the posyandu for during the last three months, and 100% of mothers added that the posyandu had a supplementary food provision program. The results of the enabling factors show that 100% of mothers have the support of family and community leaders to bring their toddlers to visit the posyandu, and say they need a posyandu in their residence. There was no significant relationship between enabling factors and the behaviour of mothers who brought their children to the posyandu under five (p ³ 0.05). This study includes a small number of respondents and was conducted during the COVID-19 pandemic, therefore further research can be carried out on a larger sample size and during periods outside the pandemic.

Reproduction and Fertility of Buffaloes in Nepal.

Water buffalo (Bubalus bubalis) in Nepal contributes 57% of the total milk and 36% of the total meat production in the country. The productive efficiency of Nepalese buffaloes is quite low, due mainly to subfertility and infertility. Delayed puberty and prolonged inter-calving intervals, attributed mainly by anestrus due to silent cyclicity and ovarian acyclicity, are the major forms of infertility in Nepalese buffaloes. Moreover, buffaloes in Nepal show a distinct seasonal breeding pattern, with July to December as the active breeding season, and with April to June and January to March as the low and transitional breeding seasons, respectively. Endoparasitic infection and poor nutritional status, which are more severe during the low season, are found to be the major factors causing anestrus and compromising its treatment response in buffaloes. Various hormonal protocols for timed artificial insemination (TAI) have been attempted, with a varying pregnancy outcome. Recently, an integrated technique including anthelmintic treatment, nutritional supplementation and hormone-based fertility management programs for TAI has been developed and implemented successfully. A wider adoption of this technique as a package of practices could be key to improving the reproductive efficiency of buffaloes in Nepal.

Study Characteristics of School Adolescent Girls on Iron Folic Acid Supplementation Program as the Prevention of Anemia in Adolescent

Background: Efforts to accelerate stunting reduction involve specific and sensitive nutrition interventions. School adolescent girls are the target group in reducing stunting through anemia prevention. Iron folic acid (IFA) supplementation program is the specific nutrition intervention to prevent anemia in adolescent girls. Objectives: This research aims to study the characteristics of students who received the IFA supplementation program. Methods: Research design was a cross sectional that involved 123 students from 12 public high schools in Cianjur District, West Java Province. Student’s characteristics consist of knowledge on anemia and their adherence on IFA supplementation program. Data collection is carried out by self-administering questionnaires monitored by enumerator. Data is performed by using mean ± SD and n (%). Results: Student’s knowledge on anemia mostly (61.8%) were categorized as low, as 30.9% were moderate, and only 7.3% were high. Students (44.7%) knew how to detect anemia is by measuring blood hemoglobin levels. As of 59.3% and 51.2% students knew the main causes of anemia are inadequate iron intake and blood loss during menstruation. Approximately 60-80% students recognized the common symptoms and sign of anemia. Most students (76.8%) have received IFA on a weekly basis and 41.2% students acknowledge their adherence in the IFA consumption with aim to prevent anemia (85.1%), the rest 23.4% and 14.9% due to the advice by the teachers and health officers. Students who have no adherence were due to their fear on the side effects, the tablet taste, forgetfulness, and feeling healthy. Conclusions: Iron folic acid supplementation program have been conducted and well targeted, however, student’s understanding on the objectives, benefit, and their adherence is needed to be gained.

SUPPLEMENTAL PAYMENTS AND NURSING HOME STAFFING: A CASE STUDY OF INDIANA

Abstract Adequate reimbursements are key to improving quality in nursing homes (NHs), but Medicaid payments remain low. Indiana implemented Medicaid supplemental payment program to non-state government (NSGOs) owned NHs to boost Medicaid payment rates. Under the program, NSGOs contribute the state-share of the supplemental payments through intergovernmental transfers allowing the state to claim federal matching funds. The supplemental payments are distributed between NSGOs and NHs but little is known about whether NHs invested the supplemental payments to improve staffing levels. In this study, we examine whether NHs receiving supplemental payments, proxied by NSGO-ownership, have higher staffing hours per resident day (HPRD) for registered nurse (RN), licensed practical nurse (LPN), and certified nurse aide (CNA) compared with NHs without supplemental payments. We use facility-year data on NSGO ownership (State of Indiana), staffing levels (Nursing Home Compare), and facility and resident characteristics (LTCfocus.org) on 500 NHs from 2009 to 2017. We use difference-in-difference (DD) regressions with year and facility fixed effects to estimate the potentially causal effect of NSGO ownership on NH staffing controlling for facility and resident characteristics. DD estimates suggest that NSGO-ownership is associated with decreased staffing level across all three types of staffing. More specifically, RN staffing decreased by 0.019 HPRD (p< 0.05), LPN staffing decreased by 0.041 HPRD (p< 0,05), and CNA staffing decreased by 0.089 HPRD (p< 0.001). Policymakers should increase the transparency of supplemental payment programs and audit the expenditures to ensure that supplemental payments are tied to quality improvement.

ENRICHING THE LIVES OF OLDER VETERANS: THE GEROFIT WAY

Abstract Gerofit is a clinical exercise program for Veterans ages 65 years and older with multi-morbidities and functional limitations that place them at elevated risk for institutionalization. It was declared a VHA “Best Practice” in 2017 and was selected for widespread dissemination and implementation, with over 30 Gerofit programs spanning the country. The original Gerofit program consists of supervised, facility-based exercise, offered 3 days per week in a group setting. Each exercise prescription incorporates aerobic training, progressive resistance training, and specialized exercises for balance and physical function. Everything changed in March 2020 when facilities began receiving orders to shut down face to face encounters and social distancing measures were put in place. Within six weeks, all of our sites had transitioned to group-based virtual classes, aptly called Gerofit to Home (GTH). This symposium includes 2 presentations that explore the effect of GTH on physical functioning and health-related quality of life outcomes in veteran participants during the pandemic: one focusing on resilience among GTH adopters vs. non-adopters in patients formerly participating in facility-based Gerofit; and the second focusing on patients enrolled directly in to GTH (no facility-based experience). The third presentation describes differences in physical function and health gains among Gerofit participants with and without peripheral artery disease (PAD). The fourth and fifth presentations describe augmented models of care to enrich the Gerofit experience for a) participants with supplemental nutrition programming and b) advanced physical therapy trainees through a Gerofit resident training model.

THE EFFECT OF COMMUNITY HEALTHCHOICES ON USE OF HOME AND COMMUNITY-BASED SERVICES

Abstract Medicaid claims data for the years 2013 to 2020 were analyzed to examine use of common categories of home and community-based services (HCBS) as well as the proportion of people living in nursing homes as opposed to receiving long-term services and supports in the community. There was a long-term trend prior to Community HealthChoices of a shift the locus of LTSS away from nursing homes. The implementation of managed care to deliver LTSS continued, but did not appear to accelerate this trend. However, MLTSS did appear to control to growth in hours of personal care per person both in the aggregate and longitudinally within the same individuals over time. There were decreases in the use of adult day services and home delivered meals. However, the decline in home delivered meals was more than offset by an increase in uptake of the supplementary nutritional assistance program (SNAP).

REBALANCING LONG-TERM CARE: THE ROLE OF MEDICAID-MANAGED LONG-TERM SERVICES AND SUPPORTS

Abstract From 2018 to 2020, Pennsylvania conducted a phased implementation of a mandatory Medicaid managed long-term services and supports program called Community HealthChoices (CHC). The new program covers people receiving Medicaid financed long-term services and supports (LTSS) in nursing homes and home and community-based settings. The three participating MCOs are incentivized to serve people in the community. This study took advantage of the phased implementation to generate causal estimates of the effect of the new program on both the extensive margin (the proportion of people receiving HCBS vs. nursing homes), and the intensive margin (the type and amount of HCBS services). Medicaid claims data for the years 2013 to 2020 were analyzed to examine pre-program trends and program effects. There was a long-term pre-program trend away from nursing homes. The implementation of managed care did not appear to accelerate this trend, however, analysis of data from 2020 is complicated by the COVID-19 pandemic. However, MLTSS did appear to control to growth in hours of personal care per person both in the aggregate and longitudinally within the same individuals over time. There were decreases in the use of adult day services and home delivered meals. However, the decline in home delivered meals was more than offset by an increase in uptake of the supplementary nutritional assistance program (SNAP). This is the first causal analysis of the effects of managed care on use of long-term services and supports. The findings have implications for other states that are considering implementing similar policies.