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This article examined whether participation in the Supplemental Nutrition Assistance Program (SNAP) produced changes to adult and child health and health care utilisation during a period of economic recession.
Instrumental variables analysis relying on variation in state SNAP policies to isolate exogenous variation in household SNAP participation.
Nationally representative data on child and adult health from the 2008 to 2013 National Health Interview Survey.
Participants were 92 237 adults and 45 469 children who were either eligible for SNAP based on household income and state eligibility rules or were low income but not eligible for SNAP benefits.
For adults, SNAP participation increased the probability of reporting very good or excellent health, and for both adults and children, reduced needing but having to go without dental care or eyeglasses. The size of these benefits was especially pronounced for children. However, SNAP participation increased the probability of needing but not being able to afford prescription medicine, and increased psychological distress for adults and behavioural problems for children under age 10.
SNAP’s benefits for adult health and improved access to dental and vision care for adults and children suggest benefits from the program’s expansions during the current COVID-induced crisis. Predicted negative effects of SNAP participation suggest the need for attention to program and benefit structure to avoid harm and the need for continued research to explore the causal effects of program participation.
Mental Health Systems and Policy: Introduction to Part III
Gary S. Cuddeback, School of Social Work, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill,
Joseph P. Morrissey, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
Obtaining care for severe and persistent mental illness has been a challenge because each service area has its own special purpose and funding mechanisms whereas those with severe and persistent mental illnesses need a broad array of services. Hence there has been much effort to produce service integration. Cuddeback and Morrissey review the experiences of service integration and consider four major innovations (Community Mental Health Centers; the Community Support Program and its spin-off, the Child and Adolescent Service System Program; the Program on Chronic Mental Illness; and efforts to introduce managed mental health care). Recent demonstration programs to integrate services have been subjected to comprehensive outcome evaluations. The research from two of these demonstrations produced similar findings; there was strong evidence for service system change and improvement, but little consistent evidence for improved client-level outcomes. The authors include a discussion of the evidence-based practice movement. The chapter concludes by describing opportunities for further research. Without a national policy for health and welfare programs, it is difficult to see how the various needs of those with severe and persistent mental illnesses will be met. Students may want to list the number of agencies in their own communities who provide services to those with severe and persistent mental illnesses, and question providers about gaps in such services as well as issues of coordination.
Over the past fifty years, the US mental health system has shifted from a centralized, institutional model based largely on state mental hospitals to a decentralized, community-based system involving several thousand public and private providers (Grob, 1991a). In this process of deinstitutionalization (Morrissey, 1982; Mechanic & Rochefort, 1992) many thousands of long-stay patients who had a severe and persistent mental illness (SPMI) were transferred to nursing homes or released directly to community settings. In addition, the growth of psychiatric services in community mental health centers attracted many more thousands of formerly unserved patients. As a result, the mental health services system expanded enormously and moved from a predominantly inpatient to a predominantly outpatient array of services (Goldman & Taube, 1989). These changes have benefited persons with acute care needs and those with milder conditions but, in a number of respects, they have disadvantaged persons with SPMI.
This chapter reviews the experiences with services integration (SI) in the broader U. S. health and welfare arena as a context for considering its applications in the mental health field over the past few decades. It then considers four major innovations as examples of SI in the mental health field-community mental health centers (CMHCs), the Community Support Program (CSP) and its spin-off, the Child and Adolescent Service System Program (CASSP), the Program on Chronic Mental Illness (PCMI) cosponsored by the Robert Wood Johnson Foundation (RWJF) and the U. S. Department of Housing and Urban Development; and the introduction of managed mental health care. The chapter then considers the effectiveness of SI with a focus on evaluation findings from the RWJF, PCMI and the Ft. Bragg children's mental health demonstration. It reviews the emergence of the evidence-based practice (EBP) movement and the interface between SI and EBP.
Fasciola hepatica secretes proteolytic enzymes and other molecules that are essential for host penetration and migration. This mixture may include enzymes required for the degradation of supramucosal gels, which defend epithelial surfaces against pathogen entry. These contain hydrated mucins that are heavily glycosylated. Excretory-secretory products (ES) from F. hepatica were examined for a range of glycosidase activities, using synthetic 4-methylumbelliferyl glycosides as substrates. The ES product contained at least 8 different glycosidase activities, the most abundant of which were β-N-acetylhexosaminidase, β-galactosidase and β-glucosidase. Alpha-fucosidase, β-glucuronidase, α-galactosidase, α-mannosidase and neuraminidase were also present. β-N-acetylhexosaminidase and β-galactosidase were present in multiple isoforms (at least 4), whereas β-glucosidase appeared to exist as one isoenzyme with a pI <3·8. All three enzymes had acidic pH optima (4·5–5·0). Ovine small intestinal mucin was degraded by ES at pH 4·5 or 7·0, with or without active cathepsin L, the major protease found in F. hepatica ES. The ability of F. hepatica ES to degrade mucin in the presence or absence of active cathepsin L suggests that cathepsin L is not essential for mucin degradation. The abundance of β-galactosidase and β-hexosaminidase in ES supports a role for these enzymes in mucin degradation.
This investigation was designed to evaluate the effects of the dietary inclusion of vegetable oil and its composition on fatty acid composition and lipid oxidation in pig muscle. Pigs were given the following diets from 50 kg to slaughter (90 kg): a control diet with no added fat (NF) or diets containing 20 g/kg of sunflower (SUN), olive (OL) or sunflower + linseed (SUN + LIN) oils. Meat from pigs given the SUN + LIN diet showed the highest thiobarbituric acid reactive substances (TBARS) from day 3 of refrigerated storage to the end of the experiment (P < 0·05). The OL group showed the lowest TBARS after 9 days of storage (P < 0·05). Pigs on NF showed intermediate values that were generally closer to those recorded for pigs given the SUN + LIN than the OL diet. By day 9, there was no statistical difference between the NF and the SUN + LIN group. The SUN group also showed intermediate TBARS throughout storage, with no statistical differences compared with the NF group. After 9 days of storage the lowest CIELAB a* value, corresponded to the SUN + LIN group and the highest to the OL group. These results indicate similar behaviour to that of lipid oxidation. Meat samples from pigs given the diet not enriched with fat showed greater drip loss than those given the remaining diets (P < 0·05) while there was no significant effect of dietary fat source on water-holding capacity. The inclusion of oils rich in linoleic fatty acids in pig diets modifies muscle fatty acid composition but susceptibility to lipid oxidation does not appear to be increased with respect to that occurring in pigs given diets with no added fat.
Interest in the role of vitamin E in disease prevention has encouraged the search for reliable indices of vitamin E status. Most studies in human subjects make use of static markers, usually a-tocopherol concentrations in plasma or serum. Plasma or serum α-tocopherol concentrations of < 11.6, 11.6–16.2, and > 16.2 mmol/l are normally regarded as indicating deficient, low and acceptable vitamin E status respectively, although more recently it has been suggested that the optimal plasma α-tocopherol concentration for protection against cardiovascular disease and cancer is > 30 μmol/l at common plasma lipid concentrations in combination with plasma vitamin C concentrations of > 50 μmol/l and > 0.4 mmol β-carotene/l. Assessment of vitamin E status has also been based on α-tocopherol concentrations in erythrocytes, lymphocytes, platelets, lipoproteins, adipose tissue, buccal mucosal cells and LDL, and on α- tocopherol: γ-tocopherol in serum or plasma. Erythrocyte susceptibility to haemolysis or lipid oxidation, breath hydrocarbon exhalation, oxidative resistance of LDL, and α-tocopheryl quinone concentrations in cerebrospinal fluid have been used as functional markers of vitamin E status. However, many of these tests tend to be non-specific and poorly standardized. The recognition that vitamin E has important roles in platelet, vascular and immune function in addition to its antioxidant properties may lead to the identification of more specific biomarkers of vitamin E status.
Clinical judgment is increasingly being challenged by the need for randomized clinical trials. The 1987 National Cancer Institute mandate—that the Community Clinical Oncology Program (CCOP) accrue patients to cancer control protocols—provided an opportunity to examine the factors that affect accrual performance. An analysis of 52 CCOPs and their research bases participating in the program found that the availability of protocols, involvement with research base activities, a demonstrated link to community physicians (particularly those physicians, such as surgeons, who had access to patients), and the use of personal contacts to inform non-CCOP physicians about CCOP activities were important facilitating factors for accruing patients to cancer prevention and control trials.
The effect of heated sunflower oil consumption on α-tocopherol status, fatty acid composition and oxidative stability of chicken tissues was investigated. Chicks were fed on diets containing (g/kg): fresh sunflower oil (FSO) 40, heated sunflower oil (HSO) 40 or heated sunflower oil (40) supplemented with α-tocopheryl acetate (HSE) to a similar α-tocopherol concentration as the FSO diet. Concentrations of α-tocopherol in tissues of chicks fed on HSO and HSE were significantly lower than those of chicks fed on FSO. Significant correlations were observed between plasma α-tocopherol concentration and the α-tocopherol concentrations of other tissues (r < 0·67, P < 0·005) and between log plasma α-tocopherol and plasma thiobarbituric acid-reacting substances (TBARS) concentrations (r – 0·851, P < 0·001). The concentrations of TEARS in tissues of chicks fed on the various diets were generally very similar before stimulation of peroxidation with Fe–ascorbate. Susceptibility of tissues to Fe–ascorbate-induced lipid peroxidation was increased by feeding HSO. Supplementation with α-tocopheryl acetate reduced susceptibility tc lipid oxidation to varying degrees, depending on the tissue. The results suggest that chronic ingesrion of oxidized lipids may compromise free-radical-scavenging activity in vivo by depleting α-tocopherol in the gastrointestinal tract, or possibly in plasma and other tissues.
Vitamin E functions as an antioxidant in animal tissues. Deficiency has been associated with sudden deaths in suckling and growing pigs as well as impaired immune function and reduced fertility. Of the tocopherols and tocotrienols present in nature, only a-tocopherol (a-T) appears in appreciable amounts in pig blood and tissues. A previous trial (Monahan et al., 1990) had shown that feeding a diet containing a high level of a-tocopherol to sows from day 3 of lactation resulted in a significant increase in sow plasma, sow milk and piglet plasma a-T levels. The present trial was designed to study the effect of feeding high a-T from late pregnancy or from farrowing on milk a-T levels.
A case of stridor is described which was due to the presence of a foreign body in the larynx of an infant. Following partial removal, compression of the right main bronchus was detected because of continuing low arterial oxygen saturation. The use of pulse oximetry allowed this complication to be identified, and the advantages of this method of monitoring are discussed.
The interdependence of mind and heart forms the basic dynamism in human consciousness. In modernity, however, this vital duality has often been obscured by the infamous dualism between reason and emotion, whereby reason is reduced to an abstract rationalism and emotion is identified with irrational passions—a view that has ancient roots. Given this confused state of affairs, the recovery of an authentic emotional life is not only essential for the preservation of human integrity but also for the possibility of authentic religious knowledge. This essay considers the work of John Macmurray, a rather neglected contemporary philosopher whose reflections on this matter remain worthy of study. Relating his personalist thought to Plato's preeminent myth of the erotic soul will serve to construct on solid footing a philosophy of consciousness that pays due respect to the Pascalian “reasons of the heart.” A wholistic understanding of human personality emerges, one based on an “emotional rationality” that is the condition for authentic human love and the incarnate medium for divine revelation.
The effect of dietary zinc deficiency on γ-glutamyl hydrolase (EC 22.214.171.124) activity and on pteroylpolyglutamate absorption was investigated in rats. Enzyme activity was determined in pancreas and gut lumen washings. Pteroylpolyglutamate absorption was studied by determining the rise in plasma folate levels following pteroylpolyglutamate ingestion. Two experiments were performed; in each purified diets were given to three groups of immature male Wistar rats for approximately 2 weeks. One group was given a Zn-deficient diet ad lib. (ZD), the second was pair-fed daily with this group on a Zn-adequate diet (PF) and the third was given the Zn-adequate diet ad lib. (AL). In Expt 1, significantly reduced pancreatic γ-glutamyl hydrolase activity was observed in ZD rats. In Expt 2, pteroylpolyglutamate was administered on day 14 and in the 3 h period following pteroylpolyglutamate ingestion, lumen γ-glutamyl hydrolase activity and plasma folate levels were significantly lower in ZD rats. Pancreas is reported as the source of lumen γ-glutamyl hydrolase in rats. The results presented indicate that the pancreatic enzyme is Zn-sensitive. It was concluded that, as a result, γ-glutamyl hydrolase activity was reduced in the lumen of ZD rats. Consequently the hydrolysis and subsequent absorption of pteroylpolyglutamate was impaired in ZD rats, as indicated by the smaller rise in plasma folate levels that occurred following pteroylpolyglutamate ingestion. Results of this study concur with previous observations in human beings and rats that Zn deficiency has an adverse effect on folate metabolism.
In the perovskite-related La/Ba/Cu oxide system, the lanthanum ions can substitute on the barium sites due to a close match in the ionic radius of the two. Thus it is possible to make a solid solution La1+xBa2-xCu3Oy where O ∼ x ≤ 0.5 and y ∼ 7. For the Ba-rich end member composition (x ∼ 0). the structure is orthorhombic. but as the La content increases and La begins to substitute on the Ba sites (disordered), the crystal symmetry changes from orthorhombic to tetragonal. In addition, the superconducting properties vary with increasing La content. In particular, the superconducting onset temperature is found to decrease linearly from 80 to 45 K over the compositional (x) range 0.0 → 0.375. In the La-rich limit (x = 0.5). 1/4 of the Ba atoms are replaced by La and superconductivity is lost. A correlation between oxygen ordering (annealing) and high Tc is observed for orthorhombic LaBa2Cu3Oy and inferred in the case of tetragonal La1.25Ba1.75Cu3Oy.
Addition of isolated κ-casein to milk reduced the destabilizing influence of forewarming, while the addition of isolated β-lactoglobulin (β-lg) to the κ-casein-enriched systems resulted in a loss in stability on forewarming. This effect was ascribed mainly to a β-lg:κ-casein interaction. Some individual milks were unaffected by forewarming while others were markedly destabilized by the same treatment. Addition of Ca2+ + Mg2+ and interchanging of milk sera by dialysis influenced stability.
It is concluded that milks which are destabilized by forewarming generally give a type A response (minimum in the pH–heat stability curves) and that preheat-stable milks generally give a type B curve (no minimum).