Mutu Gizi Aneka Kudapan Cokibus

Snacks are small meals usually served with drinks, both for daily use and for special occasions. Cokibus snack is a snack that is made to complement the intake of nutrients, especially for children who experience stunting. Makassar City has more malnourished children than other cities/districts, namely 22.1% underweight, 25.2% stunting, and 9.4% wasting. This study aims to determine changes in nutritional quality, namely the levels of macronutrients, iron, and calcium in various Cokibus snacks. This type of research is laboratory research. The sample consisted of 4 kinds of snacks, 1 type of Cokibus consisting of standard, and one substitution treatment of 10% snakehead fish meal. Each sample was repeated twice, so there were 16 samples in total. The research was conducted at the Food Technology Laboratory, Department of Nutrition, Poltekkes, Ministry of Health, Makassar, and the sample was examined at the Quality Control Laboratory of SMTI Makassar. The results showed that per 100 grams of various Cokibuses, the average carbohydrate content decreased -0.1%, protein content increased between 0.21% to 0.72%, fat increased 0.02% to 0.12%, iron increased between 0.43% to 0.63%. Calcium also increased between 0.29% to 0.85%. The snack with the highest increase in nutritional content was Charrot muffins, and the lowest increase in nutritional value was Chobus cupcakes.

Integrating Hepatitis C Care for opioid substitution treatment patients attending general practice: Feasibility, Clinical and Cost Effectiveness (Preprint)

BACKGROUND Hepatitis C (HCV) infection is common among people who inject drugs (PWID), yet well described barriers mean that a minority have accessed HCV treatment. OBJECTIVE The aim of this study was to examine feasibility, acceptability, clinical and cost effectiveness of an integrated model of HCV care for opioid substitution treatment (OST) patients in general practice. METHODS A pre-and-post intervention design with an embedded economic analysis was used to establish the feasibility, acceptability, clinical and cost effectiveness of a complex intervention to optimise HCV identification and linkage to HCV treatment among patients prescribed methadone in primary care. The ‘complex intervention’ comprised General Practitioner (GP) / practice staff education, nurse-led clinical support, and enhanced community-based HCV assessment of patients. General practices in North Dublin were recruited from the professional networks of the research team and from GPs who attended educational sessions. RESULTS Fourteen practices, 135 patients participated. Follow-up data was collected six-months post-intervention on 131(97.0%) patients. With regards to clinical effectiveness, among HCV antibody-positive patients, there was a significant increase in the proportions of who had a liver fibroscan (17/101(16.8%) vs 52/100 (52.0%); p<0.001), had attended hepatology/infectious diseases services (51/101(50.5%) vs 61/100 (61.0%); p=0.002), and initiated treatment (20/101(19.8%) vs 30/100 (30.0%); p=0.004). The mean incremental cost-effectiveness ratio of the intervention was €13,255 per quality adjusted life year gained at current full drug list price (€39,729 per course), which would be cost saving if these costs are reduced by 88%. CONCLUSIONS The complex intervention involving clinical support, access to assessment and practitioner education has the potential to enhance patient care, improving access to assessment and treatment in a cost effective manner.

Trade-offs in Substitution Treatment: A Qualitative Study of an Opioid Substitution Therapy Clinic as an Enabling and a Risk-Environment

This article present results from a study of clients experiences of attending a substitution treatment clinic in Copenhagen, Denmark. The study is part of a research project about the everyday lives of marginalized drug users in Copenhagen, their risk environments and their access to formal and informal resources. Thirty-eight clients participated in structured interviews, covering topics concerning, drug use, income, housing, social relations, violence, use of health and social services. A risk environment/enabling environment framework was developed to analyze the data. The research shows that the methadone clinic give the clients access to different material, social and affective resources, but that access to resources often involve different trade-offs. Such trade-offs include accepting control or socializing with drug users to get access to substitution medicine. Some clients accept such trade-offs, others do not and choose find other ways to get resources, exposing themselves to potential harm. This means that the clinic can function as an enabling, constraining and a risky environment for different clients.

PENGEMBANGAN CRACKELS (CRACKERS TEPUNG LELE DAN KELOR) SUMBER ANTIOKSIDAN SEBAGAI ALTERNATIF CEMILAN IBU HAMIL DI MASA PANDEMI

Background: The prevalence of anemic pregnant women in Indonesia in 2018 was still high which was at 48.9%. Pregnant women are vulnerable to nutritional problems and other diseases, including being infected with the Covid-19 virus. One of the preventive measures is to eat nutritious foods such as foods that are a source of antioxidants. The use of crackels (catfish crackers and Moringa) as an alternative snack for pregnant women is the right step because crackels contain high nutrients. The research objectives were to develop crackels, to analyze the nutritional content and their organoleptic quality.Methods: This research is an experimental study with substitution treatment of Moringa leaf flour towards catfish crackers conducted at the Laboratory of Mitra Indonesia University and State Polytechnic of Lampung. Six treatments were done with four repetitions. Data analysis used Microsoft Excel 2007 and SPSS for windows version 20. The tests used were non-parametric statistical tests, Anova, and paired sample t test.Result: Crackels formula that has been developed with the best acceptance and quality was formula F1 (3.49) which was derived from the addition of 10 grams of Moringa leaf flour and 30 grams of catfish flour. The best nutritional content of crackels is namely, energy 403 kcal, protein 21.3%, fat 15%, carbohydrates 45.7%, iron 8.32 mg/100g, calcium 29.6 mg/100g, sodium 672 mg/100g, and antioxidants indicated by % inhibition ranging from 32- 35% and IC50 value of 68.34%.Conclusion: The best crackels was the crackels which contain 10 grams of Moringa leaf flour and 30 grams of catfish which are effective as sources of antioxidants for pregnant women with antioxidants indicated by % inhibition ranging from 32- 35% .Keywords: anemic pregnant mother, antioxidant, catfish, crackers, moringa

Healthcare Seeking Among Swedish Patients in Opioid Substitution Treatment – a Mixed Methods Study on Barriers and Facilitators

Background: Patients in opioid substitution treatment (OST) have poorer health than the general population. Thus, they do not seek somatic health care to the extent that is medically motivated. Barriers hindering patients from seeking medical help through the conventional healthcare system result in a high degree of unmet healthcare needs. Barriers to and facilitators of OST patients’ healthcare seeking have been sparsely examined.Methods: Mixed methods were employed. The quantitative part consisted of a cross-sectional questionnaire covering questions on physical health, healthcare seeking, and barriers thereof, which was collected from 209 patients in OST. A sub-sample of eleven OST patients participated in semi-structured interviews, for the qualitative part of the study, covering experience of healthcare, lifestyle and self-images, expectations and ideals of Swedish healthcare. Results: Confirmed by qualitative data, quantitative data revealed deprioritization, fear of stigma and of being treated badly, and problems in navigation throughout the healthcare system, leading to unsuccessful establishment of contact, being most common reasons for not seeking somatic healthcare. Thus, interviewees provided a deeper knowledge of the barriers stigma, lack of means to prioritize health and difficulties navigating throughout the healthcare system, leading to resignation and deprioritization. On-site primary healthcare seemed to contribute to increased access and utilization of healthcare.Conclusion: Individual and structural barriers decreasing access to healthcare lead to increased inequalities in healthcare utilization, adding to an already deteriorating health of this ageing population. Integration of on-site primary healthcare and OST could provide acceptable and accessible healthcare. Further investigations into this subject need to be conducted.

Methadone Contrasted with Acetaminophen Codeine plus Clonidine: An Inpatient Pilot Study

Introduction: The mainstay of pharmacological management of opioid dependence is opioid substitution treatment. Methadone is a long‐acting opioid agonist, which is used for detoxification and maintenance of opioid-dependent people. Objective: Objective of the present evaluation included a comparison between methadone and acetaminophen codeine plus clonidine for management of opioid withdrawal symptoms. Methods: All patients of an acute ward of a psychiatric hospital, who met dual diagnosis of primary psychiatric disorder plus opioid use disorder, were selected as accessible sample for the current evaluation. Duration of assessment was around elven months and the study was performed according to a single-blind plan. Among 96 patients, cases, who were using methadone, before their recent admission in hospital, continued their substitution treatment according to the recommended dosage and formulation till release (n = 42). The remaining group of patients, had been given acetaminophen codeine plus clonidine, as substitution treatment, during their inpatient management (n = 54). The primary outcome measures were the ‘Cross-Cutting Symptom Measure’ and the ‘Subjective Opiate Withdrawal Scale’, which were scored at baseline, week 1 and week 2. The study was performed according to the ‘per-protocol’ analysis, and the assessor was blind with respect to the said protocols. Results: while the mean total score of primary outcome measures decreased significantly in both groups, the between-group analysis did not show any significant difference between these two groups in a head-to-head analysis. Conclusion: Acetaminophen codeine plus clonidine was as good as methadone for management of opioid withdrawal symptoms in inpatient setting.

Patient experience of telemedicine in addictions

AimsOpioid dependence has high risks and opioid substitution treatment (OST) improves outcomes and reduces deaths. Attendance at addiction specialist prescribers may be limited, particularly in rural areas. Telemedicine, such as videoconferencing, can reduce travel and improve access and attendance. Pre-COVID-19, we started a telemedicine service for patients with opioid dependence, prescribed opioid substitution treatment, requiring addiction specialist prescriber consultations. We present patient experience and assess whether patients recommend telemedicine.MethodHealth Research Authority approval for Randomized Controlled Trial of Telemedicine versus Face-to-Face (control) appointments in large semi-rural community addictions service (2500km2) using a modified Hub-and-Spoke (outreach). Adult opioid dependent patients prescribed OST and attending outreach clinics recruited. Participants received two consultations in group. Telemedicine delivered using Skype-for-business videoconferencing. Patients attended outreach clinic, where an outreach worker undertook drug testing and telemedicine conducted via the outreach workers laptop. Specialist addiction prescribers located remotely, at the Hub. Patients self-completed NHS Friends and Family Test (FFT) immediately after appointment, separate from the wider research study. Data collected Sept 2019– March 2020 (pre-COVID-19 lockdown), Microsoft Excel analysis, with qualitative thematic free-text analysis.ResultThirty completed FFTs were received, of which all participants were ‘extremely likely’ (n = 19;67%) or ‘likely’ (n = 11;37%) to recommend the Telemedicine service to friends or family, if they needed similar care. Two themes for reasons for recommending the service were; 1. Convenience (reduced travel, reduced travel time and reduced travel costs) and 2. Supportive Staff (including listening, caring and good support). One patient mentioned ‘it is a convenient way to communicate with medical staff, saving time and effort’. Regarding Telemedicine appointments, most participants responded that the timing of telemedicine appointments was good (n = 26;87%), given enough information (n = 30;100%), enough privacy (n = 28;93%), enough time to talk (n = 30;100%), involved as much as they wanted (n = 25;83%), given advice on keeping well (n = 28;93%), and NHS staff were friendly and helpful (n = 29;97%). No participants thought they were treated unfairly. When asked what went well, patient themes were: 1. Everything and 2. Communication (including listening and explaining). One patient stated ‘Everything better, telemedicing good, heard it well, everything improved this year’. In terms of what the service could do better, there were no issues identified.ConclusionThe Telemedicine in Addictions service was overwhelmingly highly recommended by patients. Patients recommended the service because of convenience and supportive staff. The use of telemedicine is acceptable to patients and could be considered more widely. Due to COVID-19, this technology may be beneficial access to addiction services.